-5— P 

(76- 


of 
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i 

BY  WILFRED  L.  tflGGS,  D.  O., 

Dean  and  Professor  of  Physiology  and  Lecturer  and  Demon- 
strator on  Theory  of  Osteopathy  in  Still  College  of  Osteopathy. 
Member  of  the  Examining  and  Operating  Staff  of  the  S.  S.  Still 
Infirmary.  Demonstrator  in  Clinics  of  Still  College  of  Oste- 
opathy. Member  American  Association  for  the  Advancement 
of  Osteopathy.  Formerly  Professor  of  Science  Idaho  State 
Normal,  Etc. 


Dee  dBoinea,  flowa 

mew  Science  publisbing  Co. 

1000 


LOB 
$ 

Ifoo 


KENYON  PR4NTHMI  *  MM.  CO. 

DCS  HOINB«,K>WA. 


TO 

Those  who  would  find  in  the  natural  arrangement 
of  the  various  parts  of  the  human  body 

the  source  of  perfect  order,  harmony  and  health 
this  volume  is  respectfully  dedicated  by 

THE  AUTHOR 


1900 

COPYRIGHT  APPLIED  FOR  BY 
RIGGS  AND  HELM 


CONTENTS. 


PAGE. 

HEALTH  AND  DISEASE 15 

PRINCIPLES  OF  OSTEOPATHY 41 

SYMPATHETIC  NERVOUS  SYSTEM 61 

VASO-MOTORS 85 

OSTEOPATHIC  CENTERS 95 

THEORY  OF  THE  TREATMENT  OF  THE  SPINE  .   .107 

REGIONS  OF  THE  HEAD  AND  THORAX 119 

REGIONS  OF  THE  ABDOMEN  AND  PELVIS  .  .   .   .147 

THE  lyiMBs 164 

GYNECOLOGY  AND  OBSTETRICS 179 

CONSTIPATION,  RHEUMATISM  AND  CATARRH  .   .193 

How  AND  WHEN 207 

INDBX  GENERAL .  .  .  212 


PREFACE. 


IN  THE  preparation  of  this  volume  the  author  has 
freely  drawn  from  the  rich  store  of  anatomical 
and  physiological  facts  which  are  a  part  of  general 
science.     For  this  he  makes  no  attempt  to  give  credit 
save  in  a  general  way. 

He  has  read  the  following  works  —  On  anatomy  : 
Allen,  Gray,  Gerrish,  Morris  and  Quain.  On  physi- 
ology :  The  American  Text  Book,  Dalton,  Flint, 
Foster,  Stewart  and  I^andois  &  Stirling.  On  Osteop- 
athy he  has  read  with  profit  the  works  of  the  distin- 
guished founder,  Dr.  A.  T.  Still,  Dr.  Chas.  Hazzard, 
Dr.  C.  P.  McConnell,  Dr.  A.  P.  Davis  and  Dr.  Henry. 
Miscellaneous :  Ranney's  Applied  Anatomy  of  the 
Nervous  System,  Ranney's  Diseases  of  the  Nervous 
System,  Hilton's  Rest  and  Pain,  Holden's  Landmarks, 
Robinson's  Abdominal  Brain.  On  examination  and 
diagnosis  :  Page,  Vierordt,  Cor  win,  Hare,  and  Cohen 
and  Eshner.  Osier's  Practice  of  Medicine,  Hughes' 


Practice  of  Medicine,  American  Text  Books  of  Medi- 
cine, Surgery,  Obstetrics,  Gynecology.  On  Massage 
the  author  has  read  with  pleasure  and  profit  the  works 
of  Taylor  and  Dowse. 

To  the  many  Osteopaths  with  whom  he  has  been 
associated  the  author  would  say,  "  I  am  a  part  of  all 
that  I  have  met, ' '  and  whatever  of  merit  may  be  found 
within  this  volume  is,  in  a  measure,  due  to  those  with 
whom  he  has  so  fortunately  come  in  contact. 

The  author  is  deeply  indebted  to  Dr.  J.  W.  Hofsess 
and  to  Captain  D wight  H.  Kelton,  for  many  valuable 
criticisms  and  corrections  while  the  work  was  passing 
through  the  press. 


INTRODUCTION. 


/^\F  MAKING  many  books  there  is  no  end  "  was 
a  truth  three  thousand  years  ago :  it  is 
eminently  true  at  the  present  time.  There  is  nothing 
which  so  interests  the  human  race  as  does  an  advance 
in  the  method  of  restoring  to  health  a  diseased  body. 
That  the  administration  of  drugs  has  been  empirical 
and  that  the  knowledge  of  their  effects  has  been 
bought  at  a  great  price  is  well  known,  but  tradition 
still  fetters  the  progress  of  the  healing  art. 

Aught  which  differs  from  the  fixed  order  of  belief 
as  recognized  by  the  profession,  is  condemned  in 
advance  and  must  run  the  gauntlet  of  criticism  and 
opposition.  To  elucidate  a  method  of  healing  which 
is  based  upon  known  facts  of  science  is  certainly 
a  gratifying  task.  There  is  no  fact  of  anatomy  which 
may  not  be  of  value  to  the  osteopathic  physician.  He 
uses  all  anatomical  connections  and  relations.  He 
must  be  a  bloodless  surgeon,  whose  scalpel  never 
punctures  the  skin,  nor  sections  the  nerve,  nor  severs 
the  tendon.  His  knowledge  of  anatomy  must  be 


10 

minute  and  profound,  to  the  end  that  he  may  diagnose 
diseased  conditions  though  far  removed  from  the 
functional  lesion. 

' '  Despise  not  the  day  of  little  things "  is  a  text 
which  the  osteopathic  practitioner  should  embody  into 
his  code  of  morals  for  daily  repetition.  The  minute 
nerve  twig  extending  from  spine  to  distant  organ  or 
viscus,  unimportant  in  size,  is  pregnant  with  sugges- 
tions of  the  cause  of  the  disturbed  function.  But, 
while  a  knowledge  of  anatomy  is  essential  to  the 
thoroughly  equipped  practitioner,  he  must  likewise  be 
master  of  the  known  facts  of  physiology  ;  it  is  not 
enough  that  the  osteopathic  physician  be  able  to  fore- 
tell from  the  location  of  the  lesion  the  viscus  which  is 
affected  ;  he  must  be  able  to  predicate  the  nature  of 
the  disturbed  function  and  its  general  result  upon  the 
health  of  the  patient. 

There  can  be  no  pathological  changes  in  a  tissue 
or  organ  which  are  not  accompanied  by  disturb- 
ances in  the  metabolism  of  the  part,  and  metabolism  is 
wholly  dependent  upon  the  conditions  of  nutrition 
and  nerve  supply. 

Osteopathy  is  a  protest  against  the  growing  practice 
of  taking  drugs.  It  offers  a  more  rational  means  and 
bases  its  promises  of  cure  upon  the  fact  that  in  a 
healthy  organism  in  perfect  repair  there  is  no  pain,  no 


11 

weakness,  no  disorder,  and  no  disease.  The  laws  of 
nature  are  immutable.  Water  flows  in  sparkling 
streams  from  mountain  springs  to  the  distant  ocean  in 
obedience  to  these  laws.  The  woody  fibres  of  the 
massive  tree  have  been  raised  high  in  the  air  obedient 
to  these  same  forces. 

The  science  of  Osteopathy  has  magnified  the  impor- 
tance of  the  spine  as  a  guide  in  diagnosis,  basing  such 
diagnosis  upon  the  well-known  physiological  law  of 
transferred  sensation,  and  the  anatomical  connection 
between  spine  and  viscus.  From  this  fact  comes  our 
accuracy  in  diagnosis,  an  accuracy  which  is  based 
upon  mathematical  calculation  and  cannot  fail.  The 
variations  which  occur  in  the  relations  and  struc- 
ture of  different  parts  of  the  organism  sometimes 
produce  embarrassing  results  to  the  surgeon  and  fatal 
ones  to  the  patient.  These  variations  are  rarely  suffi- 
cient to  embarrass  the  osteopath,  though  he  must  ever 
be  ready  to  correct  errors  in  diagnosis  due  to  varia- 
tions in  position  of  lesion,  by  examination  of  the 
viscus  affected. 

Every  method  of  examination  known  to  the  medical 
world  must  be  utilized  to  correct  and  to  prove  the 
accuracy  of  the  strictly  osteopathic  diagnosis. 

The  term  lesion  is  used  in  osteopathy  in  a  free 
sense  as  a  cause  of  disease,  but  it  is  not  restricted  in 


12 

its  meaning  to  osseous  dislocations.  That  there  are 
spinal  lesions  associated  with  the  great  majority  of 
diseases  is  a  fact  to  which  every  osteopathist  can  cer- 
tify. In  many  cases  these  are  the  causes  of  the 
diseased  conditions  ;  in  many  others  they  are  the 
direct  results,  yet,  as  sequelae,  serving  to  prolong  the 
disease. 

The  science  of  Osteopathy  is  progressive.  It  makes 
a  distinct  advance  in  the  art  of  healing.  It  demands 
no  external  aid  but  recognizes  in  man  the  power  to 
successfully  militate  against  the  adverse  conditions  in 
which  he  is  placed.  There  is  no  hypnotic  so  con- 
ducive to  restful  sleep  as  an  equalized  nerve  force,  no 
stimulant  so  effective  as  a  perfect  circulation,  no  reac- 
tion so  natural  as  that  rest  which  follows  physiological 
action.  The  blood  is  the  life.  The  nerve  controls  the 
condition  and  distribution  of  the  blood.  The  science 
rests  upon  the  truth  that  pure  blood  and  normal  nerve 
supply  give  health.  The  arrangement  of  the  other 
tissues  of  the  body  are  for  and  to  this  end. 

This  science  marks  a  new  departure  in  three  things 
pertaining  to  diseased  conditions,  viz. :  etiology,  diag- 
nosis and  treatment. 

There  is  no  authority  in  etiology  save  anatomy  and 
physiology.  The  symptoms  elicited  and  observed  are 
but  the  logical  results  of  some  interference  with 


13 

physiological  function.  Most  of  the  facts  upon  which 
Osteopathy  rests  are  the  common  possession  of  the 
medical  world  ;  but  the  classification  of  these  facts  have 
given  shape  and  system  to  the  science.  The  resistant 
and  recuperative  powers  of  the  body  are  being  demon- 
strated. Order,  perfect  order,  in  the  human  frame 
results  in  a  perfect  performance  of  all  the  duties  of 
that  organism.  The  curve  of  the  muscle,  the  glow  of 
the  skin,  the  gleam  of  the  eye,  all  betoken  a  perfect 
adaptability,  an  undisturbed  motion  of  fluids,  a  condi- 
tion called  health. 

The  science  of  Osteopathy  is  an  exact  one.  The 
symptoms  point  the  lesion ;  the  location  and  kind  of 
lesion  suggest  the  treatment ;  its  correction  results  in 
a  restoration  to  health. 

The  osteopathic  physician  finds  no  force  outside  the 
body  which  will  maintain  health  or  life.  He  trusts  to 
liberating  and  equalizing  the  forces  of  the  organism 
through  the  movements  of  the  fluids.  Motion  is 
essential  that  the  matter  of  the  body  may  manifest 
itself ;  and  this  manifestation  is  life. 

External  forces  produce  a  powerful  and  continuous 
effect  upon  the  central  nervous  system.  These  influ- 
ences reach  the  center  through  the  various  afferent 
pathways,  either  consciously  or  unconsciously  contrib- 
uting to  life.  The  function  of  the  air,  the  sunlight, 


14 

temperature,  meteorological  conditions ;  these  and 
many  other  forces  contribute  to  one  general  state  of 
health.  It  is  upon  this  view  that  we  seek  to  restore 
health  by  changing  the  nature,  quality  and  amount  of 
these  forces. 

Passive  movement  has  certain  curative  value. 
Motion  may  have  been  diminished ;  this  decrease  of 
motion  may  lead  to  a  loss  of  afferent  impulses  from  the 
surrounding  parts  and  thus  to  a  diminution  of  physio- 
logical processes.  The  science  of  Osteopathy  is 
entitled  to  separate,  careful,  special  investigation, 
whereby  its  facts  and  principles  may  be  recognized  at 
their  true  therapeutic  value. 

This  method  has  the  broadest  affiliations  with  gen- 
eral science,  resting  upon  all  known  truths  of  physi- 
ology, and  in  harmony  with  each. 


CHAPTER  I. 


HEALTH  AND  DISEASE. 


"  TV/TENS  SANA  IN  CORPORE  SANO"  is  an 

i-T  J.  old  L,atin  aphorism  of  which  Rousseau,  andbody 
the  great  French  savant  and  philosopher,  remarked 
that  it  is  a  short  but  complete  description  of  a  per- 
fect state  in  this  world.  These  conditions  assumed, 
all  other  earthly  conditions  are  attainable.  All  things 
are  possible  to  the  fearless,  perfect  soul ;  and  fearless- 
ness comes  only  as  an  attribute  of  a  perfect  mental  and 
physical  condition.  The  body  and  mind  are  intro- 
active.  The  mind  rules  the  body,  yet  the  body  in 
turn  reacts  most  profoundly  upon  the  mind.  Bodily 
health,  perfect  bodily  condition,  insures  mental  health. 
Health  is  the  end  of  ^dl  therapeutics.  It  represents 
the  natural  condition.  It  is  not  an  end  of  life  but  a 
means  to  perfect  living.  Health  may  be  defined  as 
that  condition  of  the  organism  which  pertains  when 
every  organ  is  perfectly  adapted  to  perform  the  func- 
tion for  which  it  was  designed.  Nor  is  this  condition 


Health  is  a 
birthright. 


The  health  of 
the  coming 
ages. 


16 

of  health  unattainable  —  in  fact,  it  is  or  should  be  the 
heritage  of  everyone — a  universal  birthright.  To 
this  end  every  child  that  is  born  has  a  right  to  demand 
that  it  come  of  healthy  parentage — that  weakness  and 
pallor  and  disease  should  not  propagate  their  kind, 
that  health  may  be  a  universal  possession  of  the  domi- 
nant races.  When  that  time  has  come  then  will  the 
profession  of  physician  become  a  thing  of  the  past, 
since  the  knowledge  which  he  possesses  as  expert,  or 
professional  attainments,  will  then  have  become  general 
knowledge  —  a  part  of  the  common  possessions  of 
mankind.  Then  children  will  remain  unborn  from 
diseased  parentage  ;  then  those  who  are  born  will 
develop  to  that  growth  and  strength  which  is  their 
right,  as  does  the  twig  grow  into  the  tree  or  the  young 
of  the  untamed  animals  reach  their  maturity,  un- 
hampered by  pain,  untouched  by  disease.  There  will 
come  a  race  with  nerves  unracked  by  pain,  which  have 
never  yielded  to  the  seductive  effects  of  the  deadly 
anodynes.  Then  strength  will  be  the  glory  of 
man  and  woman,  and  weakness  and  sickness  a 
disgrace.  That  day  will  see  men  whose  biceps  meas- 
ure will  exceed  that  of  the  neck ;  and  wasp-waisted 
women  will  be  a  tale  that  is  told  —  a  tradition  of  the 
barbarous  past.  This  condition  is  typified  in  L,ong- 
fellow's  "Village  Blacksmith"— 


17 

"The  smith,  a  mighty  man  is  he, 
With  large  and  sinewy  hands, 
And  the  muscles  of  his  brawny  arms 
Are  strong  as  iron  bands." 

To   maintain   this  state  and   to   restore   it  if   lost,   carelessness 

causes  disease. 

has  been  the  object  of  all  systems  of  therapeutics. 
Carelessness,  a  trait  of  the  race,  has  caused  man  to 
disregard  prophylaxis  and  to  trust  more  and  more  to 
what  are  considered  as  curative  agents.  So  long 
as  there  is  no  noticeable  deviation  from  the  usual  con- 
dition of  ease,  comfort  and  strength,  just  so  long  will 
the  body  receive  no  thought.  Health  is  modest, 
retiring.  Subjectively  it  is  unobtrusive  and  calls  for 
no  thought.  Objectively  it  is  prominent  and  com- 
mands attention.  '  Tis  the  condition  which  excites 
the  admiration  of  all ;  the  envy  of  those  who  have 
been  so  unfortunate  as  to  lose  it,  for  health  is  a  jewel 
unesteemed  till  lost,  but  once  lost  not  all  the  wealth  of 
Golconda  can  replace  it.  Longfellow  says,  "Life 
without  health  is  a  burden  ;  with  health  is  a  joy  and 
gladness."  Empedocles  delivered  the  people  of 
Selinus  from  a  plague  by  draining  a  marsh  and  was 
deified  and  a  coin  was  struck  in  his  honor.  But 
simple  as  may  seem  this  condition,  there  is  necessary 
a  great  amount  of  care  in  order  that  the  organism  may 
be  maintained  in  proper  working  order.  It  may  seem 
strange  to  say  that  health  is  so  difficult  to  maintain, 


18 

but  when  we  think  of  the  manifold  intricacies  of  the 
structure  of  our  bodies,  the  wonder  rather  seems  that 
we  are  able  to  maintain  so  nearly  a  perfect  condition 
of  the  body  as  exists  in  the  majority  of  persons.  There 

Theintcrde-  J         J        r 

variomorgans.  is  such  an  interdependence  between  the  various  organs 
each  of  which  contributes  to  the  welfare  of  the  other 
that  the  disarrangement  of  a  single  one  will  lead  to  the 
disarrangement  of  the  whole.  There  exists  the  vari- 
ous systems,  nervous,  circulatory,  respiratory,  muscu- 
lar, osseous,  etc.,  so  perfectly  related  that  the  one 
cannot  be  at  all  disturbed  in  form  or  in  function 
without  profoundly  affecting  each  of  the  others.  These 
systems  interact  normally  so  as  to  produce  the  physio- 
logical functions  of  all ;  if  a  disturbance  either  prima- 
rily or  secondarily  reaches  the  nervous  system  and 
through  it  various  other  subordinate  systems,  soon 
harmony,  order  and  health  have  disappeared. 

Diet  must  play  an  important  part  in  the  health  of 

Vitality  main- 
tained by  diet,  each  community  and  each  individual.     The  vitality, 

the  resistance  of  the  body  can  be  maintained  only  by 
a  dietary  affording  the  proper  amount  of  each  of  the 
three  great  classes  of  alimentary  principles, —  carbo- 
hydrates, proteids  and  fats.  But  even  here  the  per- 
sonal desires  and  idiosyncrasies  of  the  patient  must 
largely  determine  the  particular  form  under  which 
each  class  shall  be  taken.  To  be  productive  of  the 


19 

highest  good,  the  food  should  be  palatable.  Enjoy- 
ment and  appetite  are  the  best  digestives. 

All  hygienic  knowledge  should  be  rigorously  applied 
in  the  treatment  of  disease.  Sunshine,  pure  air,  venti-  pm 
lation,  exercise  and  diet  all  are  essential  in  prophy- 
laxis and  in  the  cure.  In  maintaining  his  own  health 
or  in  advising  others  to  the  same  end,  the  osteopath 
should  never  forget  these  minor  details  which  are 
known,  and  have  been  proven  in  many  instances  to  be 
life  saving.  "  Prove  all  things  ;  hold  fast  that  which 
is  good."  Exercise,  outdoor  air,  light,  well  venti- 
lated living  and  sleeping  rooms  and  one-third  of  each 
twenty-four  hours  given  to  sleep  will  surely  contribute 
to  health,  mentality  and  virtue. 

Disease  is  the  reversed  condition.     It  represents  a  Life  compared 

to  a  whirlpool. 

change  in  the  normal  metabolic  processes.  Health  is 
maintained  by  a  proper  and  perfect  metabolism.  Into 
the  ceaseless  vortex  certain  substances  are  continually 
entering,  losing  their  identity  and  momentarily  con- 
tributing to  the  whirlpool,  lending  energy  to  draw  in 
other  particles.  By  this  intussusception,  life  is  mani- 
fested, certain  low  grade  products  of  oxidation  are 
formed,  energy  is  freed.  This  regular  interchange  from 
the  organic,  through  the  living  maelstrom  to  the  lower 
organic  and  to  the  inorganic,  constitutes  health.  Within 
certain  limits  the  rate  of  change  and  the  products  may 


taboltem  pro- 
duce disease. 


20 

vary  without  seriously  disturbing  the  functioning  of 
the  organs,  but  should  the  rate  of  change  be  markedly 
interrupted,  then  may  biproducts  be  formed  which 
the  depurative  organs  are  not  able  to  withdraw,  sub- 
oxides  are  formed  and  these  acting  as  toxins  interfere 
with  the  harmony  of  the  organism,  producing  disease. 
Disease  (from  dis  —  not ;  and  ease  —  a  state  of  rest)  is 
defined  as  that  state  or  condition  of  the  body  which  is 
marked  by  an  inharmonious  action  of  one  or  more  of 
its  organs,  due  either  to  abnormal  conditions  or 
structural  change.  The  causes  of  these  conditions  are 
usually  considered  as  exciting  or  the  immediately  con- 
ditioning factor,  and  predisposing  or  that  which  tends 
to  the  development  of  the  condition.  These  two  may 
be  further  subdivided  and  may  be  so  interrelated  that  a 
strict  differentiation  is  not  always  possible.  They  act 
together  in  a  majority  ®f  cases  confusing  etiology  of 
diseases  and  puzzling  the  diagnostician.  True,  in 
many  cases  there  is  a  causa  cnusans,  or  the  causing 
cause,  which  is  the  essential  predetermining  factor. 
This  is  in  many  cases  so  evident  that  the  secondary 
causes  are  apt  to  be  overlooked.  In  addition  to  the 
foregoing  causes  of  disease  there  are  the  ordinary 
causes,  such  as  change  in  temperature,  seasonal  and 
climatic  variation,  altitude,  etc.,  to  which  all  persons 
are  more  or  less  exposed  and  against  which  the 


21 

resisting  power  of  the  individual  is  ordinarily  sufficient 
protection . 

Classifying    causes    of    diseases    as     internal  and 
external,  we  have  the  following  : 

Causes  acting  from  within  : 

1.  Heredity  —  Parents   to   off- 
spring, transmitting  either  dis- 
ease or  a  tendency  to  disease. 

I.     Predisposing 

2.  Individual   peculiarities  not 

inherited  —  connate    and    ac- 
quired. 

II.     Mental  and  emotional  causes. 

III.  Structural  lesions  —  secondary  to  or  resulting 

from  any  of  the  above. 

IV.  Abnormal  blood  supply. 
V.     Altered  nerve  influence. 

Causes  from  without- 
I.     Physical  or  mechanical,  producing  structural 

or  relational  lesions. 

II.     Chemical  —  substances  coming  in  contact  with 
the  organism  producing  abnormal    metab- 
olism. 
III.     Micro-organisms. 

Many    times    is    disease    produced    by   conditions   . 

•*  *  Conditions 

,  .   ,  ...  ,  ,  .  ,  .    not  always 

which  are  known  to  be  dangerous  but  which  cannot  controlled. 
be  avoided.      Man    constantly    chooses    occupations 


22 

which  are  productive  of  disease  or  resides  in  a  locality 
known  to  be  prejudicial  to  health.  We  feel  that  there 
are  other  occupations  in  which  health  would  be  ours 
in  greater  measure,  but  fitness,  desire,  etc.,  impel  us 
to  an  occupation  in  which  we  draw  heavily  and  con- 
tinually upon  our  vital  capital.  Health  is  a  means 
to  an  end,  and  in  insuring  it,  by  residence,  occu- 
pation, care  of  the  body,  etc.,  there  is  a  limit  to  the 
amount  of  premium  that  one  can  pay.  Even  life  itself 
may  be  too  dearly  bought  and  death  with  duty  is  to 
be  preferred  to  life  with  dishonor,  cowardice  and 
shame.  The  question  comes  to  all,  what  can  I  afford 
to  pay  for  health  ?  Bach  must  answer  for  himself. 
The  teacher  in  the  schoolroom  follows  day  after  day 
an  occupation  that  she  knows  is  taking  her  life  and 
strength.  The  shop  girl  hour  after  hour  and  month 
after  month  works  for  a  miserable  pittance  and  stands 
at  her  counter  because  she  knows  that  every  occupa- 
tion in  life  is  crowded  and  she  holds  with  the  tenacity 
of  hopelessness  and  fear  to  the  only  means  of  subsist- 
ence which  she  possesses. 

But  to  discuss  the  causes  of  disease.  Of  the 
predisposing  causes  of  disease,  the  most  important  are 
those  connected  with  some  peculiarities  of  the  bodily 
structure  which  may  be  (i)  inherited,  or  (2)  congenital 
but  not  inherited,  or  (3)  acquired  after  birth. 


23 

In   the   so-called   hereditary  diseases  it  is   not  the  Germg  not 

usiiaJly  trans- 
disease   itself  nor   its   direct   specific   cause  which  is  mttteatn 

hereditary 

transmitted  from  parent  to  child,  but  some  peculiarity 
of  structure  of  tissue  or  organ  which  in  the  course  of 
development  makes  the  person  peculiarly  susceptible 
to  disease  or  to  causes  which  produce  the  disease. 
These  may  be,  either  forces  acting  from  without,  or 
else  the  peculiarity  produces  disorder  itself  either  by 
excess  or  defect  of  structure  or  function.  Very  few 
diseases  may  be  transmitted  directly  in  utero,  but  of 
this  number  are  syphilis,  small-pox  and  a  few  others. 
The  belief  that  the  specific  germ  of  tuberculosis  and 
scrofula  is  never  transmitted  but  that  inheritance  gives  a 
peculiar  susceptibility  to  the  disease  owing  to  weak- 
ened resistance  on  the  part  of  the  protoplasm,  is  now 
prevalent  though  not  proven. 

Heredity  plays  a  part  in  immunity  just  as  it  does  in  immunity  by 

heredity. 

liability  to  disease.  This  is  seen  not  only  in  the 
family  but  on  a  broad  scale  among  races.  Perhaps 
this  even  may  be  due  to  their  obedience  to  or  neglect 
of  certain  laws  of  health.  But  certain  it  is  that  the 
negro  of  the  southern  states  is  almost  immune  against 
cancer  and  in  his  African  home  is  free  from  syphilis, 
though  in  America  is  peculiarly  subject  to  this  disease. 
He  is  peculiarly  liable  to  tuberculosis  and  immune  to 
malaria. 


Lesions, 
primary  and 
secondary, 
causes  of 
disease. 


24 

The  term  lesion  as  used  in  this  work  includes 
any  deviation  from  the  normal  either  in  structure, 
relation  or  function.  It  may  be  either  a  causa 
causans,  or  it  may  act  as  an  exciting  cause  of  disease 
either  with  predisposing  causes  or  with  other  causes 
from  without.  In  other  words,  lesions,  as  the  term  is 
used  by  osteopaths,  may  be  either  primary  or  secondary. 
The  division  is  self  explanatory.  The  term  primary 
lesion  is  ordinarily  restricted  to  conditions  which  pro- 
duce disease  ;  hence,  causative.  The  term  secondary 
lesion  is  applied  to  such  as  are  the  result  of  diseased 
conditions.  These  lesions  are  sequelae  of  previous 
diseases,  yet  may  be  causes  of  present  pathological 
conditions.  The  osteopath  seeks  for  his  lesions  along 
the  spine  and  considers  them  either  in  the  light  of 
causes  of  disease  or  of  evidences  of  a  diseased 
conditions  of  the  organ. 

These  lesions  along  the  spine  may  vary  in  kind  and 
in  degree.  The  effect  is  not  infrequently  dispropor- 
tionate to  the  amount  of  the  lesion,  sometimes  the 
least  detectable  variation  from  the  normal  may  produce 
the  most  pronounced  and  widespread  effects.  On  the 
other  hand  the  spine  is  sometimes  so  distorted  that 
one  would  expect  a  marked  interruption  to  all  the 
processes  of  life,  yet  no  such  disturbance  results. 


25 

These  spinal  lesions  may  be  of  any  of  the  following 
types  or  more  likely  a  combination  of  some  two  of 
them  : 

1.     Osseous. — This  maybe  so  pronounced  as  to  be  HOW  osseous 

lesions  ^produce 

a  dislocation,  or  so  slight  as  to  be  called  a  subluxatiou    disease. 

In  either  case  there  may  be  an  interruption  to  the 
free  passage  of  nervous  impulses  which  stream  con- 
tinually from  viscus  to  center  over  the  afferent  nerve 
fibres  entering  the  cerebro-spinal  system,  or  from 
center  to  viscus  over  the  efferent  nerve  fibres  which 
also  pass  through  the  spinal  and  cranial  foramina. 
These  nerves  serve  as  channels  for  all  communication 
between  viscera  and  center ;  these  bind  the  parts 
together  into  a  harmonious  whole ;  these  establish 
equipoise  and  health.  Every  viscus,  muscle  and 
tissue  of  the  body  is  governed  by  impulses  from  the 
centers  passing  through  these  foramina  or  through 
corresponding  openings  in  the  base  of  the  cranium. 
Likewise  through  these  go  all  those  impulses  which 
reach  the  centers  from  the  sensorium.  Sensations  of 
ease,  muscular  sense,  pressure,  temperature,  blood 
pressure,  vaso-motor  condition,  touch,  all  pass  through 
these  channels.  How  rational  that  any  change  in 
these  co-aptiug  surfaces  should  disturb  the  equilibrium 
between  the  incoming  and  the  outgoing  impulses  ;  this 
disturbance  leads  to  a  failure  of  some  one  or  more 


26 

of  the  viscera  to  function  normally,  disease  being  the 
osseous  teions,  necessary  result.     Osseous  lesions  are  usually  primary 

primary  and 

causes  of  disease  and  diseased  conditions,  though 
muscular  contractions  in  convulsions,  in  rheumatism, 
and  in  other  diseases  may  produce  actual  dislocation  of 
many  of  the  strongest  articulations  of  the  body;  so, 
too,  these  and  other  causes  may  lead  to  slight  subluxa- 
tion  of  rib  or  vertebra  which  in  turn  may  affect  some 
organ.  This  effect  may  be  deferred  or  immediate. 
This  serves  to  explain  many  of  the  sequelae  of  diseases 
which  otherwise  are  inexplicable. 
Muscular  2.  Muscular. — Aside  from  osseous  lesions  the 

lesions  effect 

nerves  reflexly.  j       ,.  r       ,.  .  ., 

next  most  productive  of  disease  is  muscular. 
This  is  usually  a  result  of  some  abnormal  condition, 
some  irritation  to  its  motor  nerve,  resulting  in  its  con- 
traction, hyperaemia,  and  hyperesthesia.  This  condi- 
tion acting  reflexly  may  irritate  the  nerves  to  the 
viscera,  there  affecting  sensory  and  vaso-motor 
conditions.  Thus  the  muscular  contraction,  itself  a 
result,  may  serve  as  a  cause  for  the  continued  disturbed 
condition  in  acute  diseases;  its  removal  is  followed 
by  an  amelioration  of  the  conditions.  These  muscular 
lesions  may  result  from  strains,  overwork,  exposure  to 
cold,  drafts,  etc. 

3.     Ligamentous. — The  third  kind  may  be  classed 
as  lesions  of  connective  tissue,  or  ligamentous.     The 


27 

muscular  lesion  always  exists  with  the  osseous  at  the  increase  of 

connective 

beginning.      It  may  exist  independent  of  it  but  in  f*™sej$£r~ 

nutrition. 

either  case  a  continual  contraction  of  a  muscle  means 
a  hyperaemia,  venous  stasis  and  retrograde  metab- 
olism, namely, —  an  increase  in  the  connective  tissue 
wrappings  of  the  muscle,  tightening  and  thickening 
the  ligaments  and  tendons  and  thus  pressing  upon  the 
channels  for  blood,  lymph  and  nerve  impulse.  This 
will  explain  why  the  osteopath  attributes  so  many 
diseased  conditions  to  lesions  ;  not  lesions  in  the  nar- 
row sense  of  dislocation,  but  in  the  sense  of  any 
abnormality  of  structure.  Their  correction  leads  in 
most  cases  to  a  cure  ;  in  all  cases  the  immediate  result 

is    to    palliate     the    condition.      The    correction    of  correction  of 

lesions 

these  lesions  is  the  removal  of  the  cause  in  many  pro 
diseased  conditions.  In  bacterial  diseases  even 
this  treatment  produces  effects  which  tend  to  cure  by 
sending  more  and  purer  blood  to  the  organ,  increasing 
the  activity  of  assimilative  and  depurative  tissues, 
increasing  the  vitality  and  strength  of  the  patient. 

It  seems  to  be  an  established  belief,  at  best  it  is  a 
prevalent  one,  that  in  all  things  the  medical  man  and 
the  osteopath  must  be  on  opposing  sides  of  every 
question ;  and  should  the  opposition  by  priority  have 
occupied  the  only  tenable  position  it  is  necessary  that 
the  osteopath  should  occupy  any  position,  however 


No  conflict 
between 
Osteopathy 
and  the 
germ  theory. 


28 

untenable,  rather  than  stand  in  the  same  position  as 
his  medical  friends.  This  need  not  be.  The  belief  in 
the  existence  of  lesions  as  a  cause  of  disease  has  led  to 
a  very  conservative  estimate  among  osteopaths  as  to  the 
functions  of  bacteria  found  in  the  body.  The  discrep- 
ancy between  the  explanation  of  the  causes  of  disease 
from  the  view-point  of  the  bacteriologist  and  that  of 
the  osteopath  is  apparent  only,  for  there  is  no  neces- 
sary conflict.  The  osteopath  acknowledges  that 
inorganic  and  non-living  poisons  introduced  into  the 
system  may  cause  disease  and  death,  and  why  not 
acknowledge,  too,  that  organisms  whose  rate  of 
increase  is  almost  unbelievable  and  the  virulence  of 
whose  products  is  scarcely  equaled  by  that  of  common 
poisons  may  not  produce  like  effects  ?  No  one,  for  a 
moment,  claims  that  carbolic  acid  or  some  of  the 
compounds  of  lead  may  not  be  the  real  cause  of 
diseased  conditions  if  introduced  into  the  body, — 
though  no  one  forgets  that  the  resisting  power  of 
some  individuals  is  greater  than  that  of  others. 

The  history  of  the  growth  of  the  idea  that  micro- 
organisms are  the  cause  of  many  of  the  diseases  that 
flesh  is  heir  to,  is  an  interesting  one.  It  entails  the 
idea  of  spontaneous  generation.  The  discussions 
which  led  to  the  positions  occupied  by  scientists  began 
before  the  Christian  era.  All  the  ancients  believed  in 


29 

spontaneous  generation.  Dead  bodies  decaying 
became  bees,  hornets,  flies,  worms  and  beetles. 
Animals  were  held  to  develop  from  moisture.  Aris- 
totle asserts  that  sometimes  animals  are  found  in 
putrefying  soil,  in  plants  and  in  the  fluids  of  other 
animals.  He  announces  that  every  substance  which 
has  become  moist  and  every  moist  body  that  has 
become  dry,  produces  living  creatures,  provided  it  is 
fit  to  nourish  them.  Two  thousand  years  later  this 
same  belief  prevailed,  extending  downward  through 
the  middle  ages,  and  incidentally  contributing  to  the 
science  of  bacteriology. 

In  1668  Francesco  Redi,  expressed  a  belief,  seem- 
ingly the  first  to  do  so,  that  maggots  formed  in 
decaying  meats  did  not  arise  de  novo,  but  were  a 
progeny  of  the  flies  which  swarmed  upon  it.  His 
proof  of  his  position  is  historic.  Covering  jars  con- 
taining the  meat  with  paper,  and  later  with  gauze,  he 
showed  that  the  flies  deposited  their  eggs  on  the 
covering,  while  the  meat  decayed  as  usual. 

It  was  at  this  time  that  Leuwenhock  (1675)  per- 
fected the  compound  microscope  to  such  a  degree  as  to 
make  it  of  some  service.  By  the  power  of  the  lens 
life  was  revealed  which  before  had  been  but  dimly 
guessed  at.  The  doctrine  of  spontaneous  generation 
again  fought  for  recognition,  while  Plengig  of  Vienna 


30 

for  the  first  time,  in  1762,  announced  a  connection 
between  the  organic  life  revealed  by  the  microscope  and 
the  origin  of  disease.  This  idea  was  for  a  long  time 
neglected,  but  other  experiments  were  carried  on  which 
led  to  the  present  position  of  scientists.  The  doctrine 
of  spontaneous  generation  was  finally  overturned  by  a 
series  of  brilliant  experiments,  beginning  with  Spal- 
lanzani.  who  subjected  sealed  flasks  with  infusorial 
fluids  to  the  temperature  of  boiling  water  and  got  no 
evidence  of  life ;  Schultze,  who  heated  flasks  and 
passed  air  through  sulphuric  acid  into  them  daily  with 
no  evidence  of  life,  made  a  vast  step  forward  in  1836  ; 
while  Schwann  proved  that  calcined  air  admitted  to 
putrescible  liquids  did  not  produce  life.  Pasteur 
demonstrated  that  meat  did  not  decay  if  kept  free 
from  germs. 

The  crucial  test  for  spontaneous  generation 
was  made  by  John  Tyndall.  He  arranged  an  air- 
tight box  with  glass  ends  in  such  a  manner  that 
test  tubes  introduced  into  the  bottom  could  be  filled 
without  communication  from  the  outside.  Waiting 
until  a  ray  of  light  passed  through  the  box  from  end 
to  end  made  no  illumination,  indicating  that  all  the 
dust  of  the  air  had  settled  to  the  bottom  or  had 
adhered  to  the  sides  which  were  oiled ;  the  test 
tubes  were  then  filled  with  such  mixtures  as  had 


31 

under  ordinary  circumstances  been  known  to  soon 
become  swarming  with  bacteria  of  putrefaction.  The 
mixtures  were  then  heated  to  the  boiling  point  and 
allowed  to  stand  for  a  few  days,  when  they  were 
heated  again.  By  this  method  of  repeatedly  raising 
to  a  high  temperature  and  allowing  it  to  cool  to  a 
temperature  at  which  development  of  bacteria  would 
take  place  he  hoped  to  thus  overcome  the  condition 
which  he  had  conceived  to  be  the  cause  of  the  failure 
of  other  experiments  of  a  similar  nature. 

His  idea  was  that  the  spores  have  a  greater  resist- 
ance to  the  action  of  heat  than  the  fully  developed 
germs,  and  that  they  had  withstood  the  tests  of  other 

Life  does  not 

investigators,  but  by  successive  heatings  he  hoped  to 
destroy  them  in  their  developing  or  in  their  matured 
state.  The  plan  proved  successful  and  it  was  demon- 
strated most  conclusively  that  life  does  not  originate 
de  novo.  The  tubes  stood  for  months  with  no  evidence 
of  life  or  decomposition.  This  experiment  proved, 
with  others  of  a  similar  nature,  that  decomposition 
does  not  take  place  except  it  be  associated  with  the 
action  of  certain  microscopic  organisms. 

Tyndall's  remarkable  experiment  finally  overthrew 
the  doctrine  of  spontaneous  generation.  The  neces- 
sary data  were  now  established  for  carrying  out  the 


32 

crucial  tests  to  which  the  germ  theory  was  subjected 
before  it  was  accepted. 

These  tests  put  in  common  language  were  as  fol- 
lows : 

The  disease  must  be  one  that  can  be  clearly  iden- 
tified. The  specific  germ  must  in  all  cases  be  capable 
Kooh'stest.  of  being  isolated.  It  must  be  present  in  the  diseased 
tissue  or  organ  and  not  merely  in  the  fluids  associated 
with  the  organ.  It  must  be  capable  of  being  reared  in 
pure  cultures  and  lastly  when  germs  from  these  pure 
cultures  are  introduced  into  the  system  of  an  otherwise 
healthy  animal,  the  introduction  must  be  followed  by 
a  disease  having  the  same  symptoms  as  the  original 
disease.  The  test  made  in  numbers  of  cases  has 
established  the  germ  theory  as  a  scientific  fact.  It 
places  the  germs  as  a  cause  of  disease  this  far,  that, 
without  the  introduction  of  the  germs  the  disease 
would  not  have  occurred.  The  osteopath  regards  the 
germ  as  an  exciting  cause  of  disease.  He  considers 
the  resisting  power  of  the  body  an  important  factor 
in  prophylaxis.  This  power  depends  upon  the  con- 
dition of  the  blood  ;  and  it  is  thus  through  the  blood 
that  the  osteopath  seeks  to  militate  against  develop- 
ment and  effects  of  the  pathogenic  germs.  The 

Red  blood  as  a  osteopath  practices  asepsis  and  antisepsis.     He  con- 
aermicide. 

tends  that  the  best  germicide  is  good  red  blood,  and 


33 

acknowledges  that  drugging  is  theoretically  the 
method  of  killing  the  germ.  The  only  difficulty 
conies  in  finding  a  drug  that  will  reach  the  bacterium. 
Unfortunately,  when  drugs  are  administered,  the 
patient  yields  to  the  effect  of  the  poison  before  the 
germ  is  killed. 

There  is  no  longer  any  discussion  among  intelligent 
men  as  to  whether  certain  forms  of  germs  are  danger- 
ous and  destructive  to  life ;  but  how  to  prevent  their 
entrance  and  to  combat  their  ravages  when  once 
entered  are  the  great  questions  for  the  physician. 

A  bacterium  may  be  defined  as  a  minute  vegetable  Definition  of 

bacteria. 

cell.  Its  component  substance  is  called  myco-protein. 
Its  chemical  nature  has  never  been  absolutely  deter- 
mined. For  convenience  of  study  those  which  produce 
diseased  conditions  are  divided  into  three  classes. 

First.  The  cocci,  which  are  spherical  in  form, 
either  existing  as  single  spores,  micro-cocci  ;  or  united 
in  pairs,  diplo-cocci  ;  or  arranged  in  chains,  strepto- 
cocci ;  or  in  clusters  or  groups,  when  they  are  called 
staphylo-cocci. 

Second.  The  bacillus  whose  form  is  more  or  less  rod 
shaped. 

Third.  The  spirilum  having  a  cork-screw  or  spiral 
form. 


34 

Experiments  have  shown  these  to  be  present  in  pro- 
fusion in  most  places,  yet  they  do  not  occur  in  the 
atmosphere  over  the  ocean  very  far  from  land,  at  the 
tops  of  mountains  nor  normally  in  the  tissues  of  the 
body.  They  follow  the  law  of  the  universe  in  that 
each  produces  its  kind,  although  under  certain  condi- 
tions it  seems  that  their  products  may  vary. 

The  term  bacteria  is  used  to  include  only  vegetable 
organisms.  Micro-organisms  may  mean  either  vege- 
table or  animal  organisms,  though  but  few  of  the 
protozoa  are  pathogenic. 

Of  the  multitude  of  bacteria  there  are  perhaps 
less  than  twenty  that  are  deleterious  to  the  system 
while  there  are  numbers  and  numbers  absolutely  nec- 
essary to  life. 

As  to  their  size  they  are  about  25  QOO  of  an  inch  in 
diameter.  Their  process  of  development  is  rapid  as  is 
their  rate  of  multiplication.  Cohn  calculated  that 
the  weight  of  a  single  germ  is  10,000,000,000  of  a  milli- 
gram, yet  under  ideal  conditions  they  multiply  so 
Rapidity  of  rapidly  that  in  three  days  a  single  germ  may  have 

development. 

reached  the  astounding  mass  of  7,500  tons,  its  progeny 
numbering  5,000,000,000,000.  So  marked  is  their 
absence  from  the  normal  tissues  of  the  body  that  their 
presence  there  is  always  taken  as  a  certain  evidence  of 
disease.  That  under  certain  conditions  they  enter  the 


35 

tissues  of  the  body  and  exist  within  them  is  not 
denied  by  any  one. 

The  marvelous  rapidity  of  development  prepares  one 
for  the  exceeding  virulence  of  many  diseases  consequent 
upon  the  activity  of  germs.  Their  products  are 
leucomanes,  ptomains  and  toxalbumins  which  destroy 
the  integrity  of  the  tissues,  overthrow  the  harmonious 
rule  of  the  nervous  centers  and  produce  death  as  the 
necessary  result  of  such  inharmony.  Bacteria  are 
variously  described  according  to  conditions  of  growth, 
as  serobiotie,  those  growing  in  the  presence  of  oxygen  ; 
and  anserobiotics,  those  which  do  not  grow  in  the  pres- 
ence of  oxygen,  while  the  term  optional  or  facultative 
aerobiotic  is  applied  to  those  which  may  thrive  under 
either  condition.  It  is  worth  more  than  passing  notice 
that  the  presence  of  sunlight  is  deadly  to  most  forms 
of  germs,  a  fact  of  fundamental  importance  in  sanita- 
tion. 

According  to  their  products  bacteria  are  divided  into 
several  classes  of  which  the  pathogenic  or  disease 
producing  kind  alone  interest  us  in  a  work  of  this  pathogenic 

germs. 

nature.  These  germs  may  be  developed  locally  and 
by  their  very  presence  block  the  channels  of  the  fluids 
to  or  from  the  part,  or  they  may  by  their  chemotactic 
power  effect  the  same  result. 


36 

Germs  of  suppuration  are  both  toxic  and  chemotac- 
tic  and  by  the  effects  of  their  toxins  upon  the  cells 
with  which  they  come  in  contact  these  in  turn  are 
destroyed  and  may  be  rendered  chemotactic.  Septic 
germs  are  those  which  multiply  in  the  liquids  and 
are  thus  distributed  to  all  parts  of  the  body. 

That  germs  cause  small-pox,  scarlet  fever,  measles 
and  other  contagious  and  infectious  diseases  no  sensible 
person  will  for  a  moment  deny.  The  proofs  are  on 
every  hand  sufficient  to  satisfy  the  inquiring  observer. 
But  not  so  with  the  exacting  scientist.  In  order  that 
a  disease  can  be  attributed  to  a  specific  germ  it  must 
comply  in  every  particular  with  Koch's  tests  mentioned 
above, — postulates  first  demanded  by  Henle  but  impos- 
sible with  the  methods  in  vogue  in  his  day. 

But  the  practical  question  comes  to  us,  ' '  How  does 
the  osteopath  treat  germ  diseases  ?  ' '  Let  me  answer 
by  another.  How  does  medicine  treat  such  cases? 
In  diphtheria,  in  pneumonia  and  in  pulmonary 
tuberculosis  it  would  seem  that  vapors  or  topical 

No  drug  a 

wrmfldiseases  application  would  prevent  the  ravages  of  the  germ, 
but  they  are  little  used.  In  typhoid  fever,  in  which  dis- 
ease the  germ  is  demonstrated  to  be  in  the  alimentary 
tract,  drugs  should  be  able  to  reach  and  destroy  all 
such  offending  organisms,  but  even  the  advocates  of 
medicine  do  not  advise  the  use  of  drugs  in  this  disease. 


37 

In  no  germ  disease  is  there  a  safe  and  certain  specific. 
The  object  of  all  treatment  is  to  increase  the  resisting 
powers  of  the  individual  until  there  has  been  estab- 
lished within  the  body  the  germicidal  powers  of  certain 
cells  or  germicidal  serum,  the  product  of  these  cells. 
When  this  condition  is  secured  then  the  germs  cease 
to  multiply,  the  toxins  are  eliminated,  the  thermogenic 
centers  are  no  longer  excited,  metabolism  is  reduced 
in  rate,  the  thermolytic  centers  function  properly, 
the  fever  falls  and  the  patient  begins  to  recover. 
Drugs  now  are  given  to  stimulate  the  circulatory 
and  other  vital  organs.  The  disease  is  self  lim- 
ited. By  the  very  product  of  the  germ  activity 
its  further  development  is  limited.  The  osteopath  in 
his  treatment  seeks  to  reduce  and  control  the  fever, 
thus  preventing  excessive  metabolism.  He  allays  osteopathy  in 

germ  diseases. 

nervousness  and  thus  maintains  equilibrium  between 
the  nervous  system  and  the  subordinate  tissues.  But 
above  all  he  removes  obstruction  to  the  circulation  in 
the  affected  organ  and  sends  to  it  the  best  blood  in  the 
body.  He  increases  oxidation  and  enriches  the  plasma 
and  nourishes  the  germicidal  cells.  He  controls  ther- 
mogenesis  and  thermolysis.  He  also  may,  in  a 
crisis,  stimulate  a  heart  as  no  medicinal  stimulant 
can  do.  Foster,  the  great  physiologist,  says  that 
electrodes  and  induction  coils  are  rough  means  and 


38 

that  we  may  more  nearly  approach  the  normal  phases 
of  nerve  action  by  mechanical  stimulation,  citing 
as  an  instance  the  reflex  inhibition  of  the  heart 
by  vagal  impulses,  the  result  of  irritating  the  abdomi- 
nal splanchnics. 

Thus  in  treatment  of  acute  diseases,  experience 
has  shown  that  by  a  knowledge  of  the  physiolog- 
ical functions  of  the  various  organs,  and  a  knowledge 
of  the  manipulations  necessary  to  arouse  the  latent 
powers  of  the  body,  the  osteopath  may  very  favor- 
ably affect  all  diseases  usually  considered  as  being 
of  bacterial  origin.  That  he  accomplishes  this  is 
shown  by  the  records  of  his  treatments  in  pneumonia, 
typhoid  fever,  measles,  diphtheria,  etc.  The  treat- 
ments result  in  establishing  an  immunity  against 
the  further  ravages  of  the  germ. 

This  condition  may  be  defined  as  the  condition  of 
an  animal  by  which  it  resists  the  entrance  of  the 
disease  producing  germs  or  their  growth  and  patho- 
genesis.  It  is  both  racial  and  individual.  There  are 
races  which  are  immune  to  or  susceptible  to  certain 
diseases.  The  negro  is  practically  immune  to  yellow 
fever ;  he  is  especially  susceptible  to  tuberculosis. 
The  Jew  is  free  from  many  diseases,  but  is  especially 
susceptible  to  diabetes. 


39 

Man,  then,  has  a  condition  of  immunity,  a  condition 
of  the  body  which  resists  disease.  Circumstances  may 
vary  this  power. 

The  virulent  germ  anthrax  very  few  animals  resist, 
but  some  do  ;  nor  can  this  resistance  be  explained  on 
structural  difference.  Immunity  may  be  destroyed  by 

Susceptibility. 

a  changed  condition  of  the  blood.  Thus,  exhaustion 
may  make  a  person  susceptible  that  would  otherwise 
have  been  immune.  The  membranes  of  the  nose  are 
supposed,  in  health,  to  be  germicidal.  Susceptibility 
may  be  defined  as  that  condition  which  favors  the 
entrance,  growth  and  development  of  pathogenic  germs 
within  the  tissues. 

There  are  various  modes  for  the  entrance  of  the 
germs  of  disease. 

They  may  have  an  entrance  through  the  skin  or 
mucous  membrane ; 

By  the  respiratory  tract,  through  its  mucous  mem- 

Modeof 

brane,  which  is  different  from  the    ordinary  mucous  entrance  of 

germs. 

membrane ; 

Through  the  digestive  tract ; 

Through  wounds ; 

Through  the  placenta  into  the  placental  circulation. 

From  these  sources  they  get  into  the  blood  stream. 
They  may  also  have  a  passive  entrance,  that  is,  they 
may  develop  and  grow  outside  and  enter  through  the 


40 

walls  of  the  vessels.  They  may  be  carried  directly 
by  the  leucocytes  or  indirectly  by  way  of  the  lymph 
stream  or  lymphatics  into  the  venous  channels. 

Prevention  of  germ  disease  can  be  best  secured  by 
isolation.  For  those  who  must  necessarily  be  exposed 
to  the  action  of  the  germs  there  is  nothing  which  will 
so  protect  against  their  entrance  and  action  as  perfect 
bodily  condition,  good  action  of  the  heart,  thorough 
respiratory  powers,  good  digestion  and  an  observance 
of  the  rules  of  hygiene. 

Disinfection  must  always  be  thorough.  It  should 
be  the  last  action  of  the  physician  at  the  termination 
of  an  infectious  case  to  cause  a  thorough  disinfection 
of  the  room,  furniture,  bedding,  etc.,  exposed  to  the 
germs.  Of  his  own  person  he  cannot  be  too  careful. 
Antisepsis  and  asepsis  are  the  safe-guards  of  every 
person  who  has  charge  of  the  health  of  others  in  time 
of  sickness. 


CHAPTER    II. 


PRINCIPLES  OF  OSTEOPATHY. 

IN  AL/L,  organic  life  the  cell  is  histologically  and 
physiologically  the  unit.     The  conditions  which 

are  essential  to  its  growth  and  development  vary.     In 

Cell  essential  to 
the  undifferentiated  state,  that  is,  before  the  histologi-  development. 

cal  differentiation  of  the  cells  into  the  various  tissues, 
the  only  thing  necessary  to  the  development  of  the 
cell  is  that  the  nourishment  be  continuous  and  the 
temperature,  of  course,  be  such  as  to  permit  of  the 
normal  actions  of  the  cell.  Instances  of  this  kind  are 
seen  in  the  unicellular  animals,  and  in  the  leucocytes 
and  similar  cells  in  man.  In  the  more  highly  differ- 
entiated tissues  the  activity  of  the  cell  is  dependent  on 
another  condition,  that  of  nervous  control.  The  nerves 
as  higher  tissues,  through  their  impulses,  act  as  con- 
trolling influences.  The  normal  performances  of  cell 
function  are  irritability,  contraction,  assimilation, 
growth,  reproduction  and  excretion.  These  functions 
summed,  modified  and  correlated  constitute  the 


42 

phenomenon  of  life.  Since  health  is  a  condition  in 
which  every  organ  and  part  adequately  performs  its 
function,  then  it  must  follow  that  the  health  of  the 
organ  is  dependent  upon  the  healthy  condition  of  the 
cell,  for  the  organs  are  composed  of  cells  and  their 
products.  The  cell  is  really  the  important  part  of 
every  tissue  and  its  health  or  disease  depends  upon  the 
blood  and  nerve  supply. 

First.     This  is  a  basic  principle  of  Osteopathy,  that 
Health  main- 

and  nerve.  °(     through  the  blood  supply  and  the  nerve  supply  to  the 
tissues,  is  the  health  of  the  body  maintained. 

Second.  It  is  a  law  of  physiology  that  any  impair- 
ment in  the  structure  or  function  of  an  organ  causes 

Tenderness 

evidence  of  a     tenderness  on  pressure,  and  tenderness  on  pressure  is 
lesion. 

the  best  evidence  of  a  lesion  of  an  organ,  that  is,  a 
lesion  in  the  sense  in  which  we  have  defined  it  —  any 
abnormal  condition.  It  is  not  always  possible  to  reach 
the  organ  directly,  but  it  is  possible  in  all  cases  to 
reach  the  efferent  or  afferent  nerve  fibres  of  the  organ. 
These  nerve  fibres  are  sensitive  to  pressure  just  as  are 
the  nerve  fibrils  in  the  organ  itself. 

Third.  Tenderness  along  the  course  of  the  nerves 
of  any  organ  is  an  evidence  of  a  lesion  of  the  organ. 
The  lesion  may  be  temporary  or  permanent. 

Fourth.  Pain  is  a  warning  of  a  pathological  state 
of  an  organ  or  a  tissue  and  may  be  referred  to  the 


43 

tissue  or  organ  affected  or  to  some  other  distribution 
of  the  nerve  through  its  branches.  Hence,  pain  as  the 
sign  of  a  lesion  may  refer  to  the  organ  affected  or  to 
the  peripheral  distribution  of  the  nerve.  There  will 
be  tenderness  somewhere.  Pain  does  not  always  warn 
you  where  the  lesion  is.  Every  practitioner  is  familiar 
with  cases  in  which  treatment  has  been  directed  to  the 
knee  when  the  trouble  is  in  the  hip.  If  you  follow 
the  pain  back  far  enough  you  will  find  it  is  due  to  the 
condition  somewhere  of  the  nonperformance  of  func- 
tion of  some  organ,  and  nonperformance  of  function 
is  a  lesion  in  the  sense  in  which  we  defined  it. 

Fifth.     Any    irritation  to  an  efferent  nerve,   either  Effect  of 

muscular 

central,  peripheral  or  along  its  course  disturbs  the  7< 
vaso-motor  and  motor  equilibrium  between  organ  and 
nerve  center  and  leads  to  a  consequent  contraction  of 
the  muscles  innervated  by  the  corresponding  segment 
of  the  central  nervous  system.  This  contraction  tends 
to  increase  the  severity  of  the  symptoms  and  to  prolong 
the  disturbed  effect.  This  same  result  follows  the 
primary  lesion  of  a  viscus,  irritating  its  afferent  nerves. 
Sixth.  Any  irritation  to  a  nerve  or  interference 
with  the  passage  of  the  physiological  nerve  impulses 
to  an  organ  may  produce  a  lesion  of  that  organ.  In 
any  case  there  will  result  a  disturbed  vaso-motor 
equilibrium  and  an  increased  contraction  and  increased 


44 

irritation  to  the  muscles  supplied  by  the  nerves  from 
its  segment. 

Seventh.  In  like  manner  a  continual  irritation  may 
lead  to  an  increase  of  connective  tissue,  shortening 
and  thickening  the  ligaments,  interfering  with  circu- 
lation, nerves  and  tendons  and  so  prolonging  the 
disease  and  aggravating  its  symptoms.  Thus,  if  the 
muscles  are  contracted  at  the  fourth,  fifth  and  sixth 
dorsal  regions,  it  means  there  is  a  variation  from 
the  usual  amount  of  blood  sent  to  that  region  and  this 
change  in  blood  supply  means  an  increase  in  growth 
of  connective  tissue.  This  increase  in  growth  of  con- 
nective tissue  around  the  vertebrae  will  overcome  the 
freedom  of  their  motion  and  lead  to  irritation  of  and 
pressure  upon  the  nerves  passing  from  this  region. 
This  irritation  is  referred  to  the  stomach  and  cannot 
be  removed  until  you  remove  the  cause.  For  this 
reason  we  invariably  treat  the  spine  to  relieve  this 
condition.  Disease  of  the  stomach  may  have  caused  a 
congestion  of  these  muscles  and  their  increase  in  size 
until  they  encroach  upon  the  pathway  of  the  nerve. 
We  must  first  overcome  the  contraction,  whether  it  be 
the  cause  or  the  product  of  the  disease.  Then  we  can 
restore  the  normal  condition  of  the  nerves  and  nature 
will  do  its  work. 


45 

Eighth.     Any  obstruction  to  the  free  passage  of  the  obstruction 

leads  to  'disease. 
efferent  impulses  to  an  organ  may  result  in  diminution 

or  a  cessation  of  the  normal  mttabolism  of  the  organ, 
either  trophic  or  secretory,  or  both,  thus  directly 
leading  to  a  diseased  condition  of  the  organ  or 
producing  a  nidus  for  bacterial  activity,  or  resulting  in 
destructive  metabolism  and  finally  in  all  cases  in 
disease. 

Ninth.      The   human   body   is  a   machine   for  the  The,  body  a 

machine. 

transformation  of  energy.  The  amount  and  quality 
of  this  energy  formed  in  a  large  measure  determines  the 
individuality  of  the  person.  The  proper  distribution 
of  this  energy  determines  the  health  of  the  individual. 
Any  interference  in  the  production,  manifestation, 
or  distribution  of  energy  will  result  in  a  changed 
metabolism  —  a  condition  called  disease.  This  dis- 
eased condition  may  remain  indefinitely  so  long  as  the 
condition  which  produced  it  remains,  the  disease  then 
being  called  chronic.  Now  any  restoration  to  health 
must  be  accomplished  by  changing  the  rate  of  manu- 
facture, the  quality  or  the  equalization  of  the  bodily 
energy.  This  cannot  be  secured  by  adding  foreign 
substances  to  the  mechanism,  but  by  the  simple  process 
of  adjustment  and  correction.  The  friction  removed, 
the  delicate  structures  replaced  in  their  proper  posi- 
tions, the  vital  actions  proceed  uninterruptedly,  ease 


46 

succeeds  disease,  strength  follows  weakness,  pain 
disappears.  There  is  no  radical  change  from  the 
usual  conditions  which  give  health.  The  organism 
demands  nothing  new. 

Tenth.  Oxidation  is  the  process  by  which  bodily 
changes  are  produced — bodily  temperature  maintained. 
Motion  increases  oxidation  and  energy.  Any  influence 
which  decreases  energy  retards  metabolism  and  forms 
incomplete  oxidation  products.  These  suboxides  are 
disease  producing.  Therefore  any  manipulation 
which  tends  to  increase  motion  removes  suboxides 
and  compels  a  restoration  to  health.  Motion  is 
health. 

Eleventh.     The   skin   is  largely  a  nervous  organ. 

Skin  a  nervous 

organism.  This  in  health  receives  the  normal  physiological 
impulses  which  pour  into  the  central  nervous  system, 
there  producing  changes  and  arousing  afferent  impulses. 
These  afferent  impulses  maintain  the  tonic  conditions  of 
glandular  and  other  tissues  of  the  body.  Any  increase 
or  decrease  of  these  impulses  may  lead  to  a  disturbance 
of  any  of  the  outgoing  impulses,  either  increasing  or 
diminishing  them.  Thus  the  skin  may,  by  artificial 
stimulation  and  a  hyperaesthetic  condition,  depurate 
the  nerve  centers,  causing  exhaustion.  On  the  other 
hand  in  conditions  of  anaemia  and  anaesthesia  stimula- 
tion of  the  sensory  nerves  in  the  skin  may  arouse 


47 

afferent  impulses  to  the  proper  physiological  degree 
which  will  restore  the  lost  vigor  and  tone. 

Twelfth.  Passive  muscular  movement  necessarily 
entailed  upon  osteopathic  treatment  serves  in  many 
cases  to  restore  the  equipoise  between  nerve  centers 
and  the  muscles  by  distributing  the  energy.  This 
means  health.  The  condition  in  many  cases  of 
disease  is  that  of  disturbed  equipoise  between  muscle 
and  nerve  centers.  Passive  muscular  exercise  serves 
to  divert  the  energy  from  the  nerve  centers  to  its 
proper  distribution,  the  muscles,  thus  re-establishing 
the  proper  equipoise  which  is  health  producing. 

Thirteenth.  When  several  muscles  are  supplied  by 
branches  of  the  same  nerve  their  function  is  to  act  in 
harmony  and  in  unison ;  this  fact  is  of  value  in 
diagnosis  of  lesion  in  case  of  loss  of  muscular  power. 
The  reader  is  able  to  supply  numerous  examples  of 
such  arrangement. 

Fourteenth.     "Superficial  pains  on  both  sides  of  the 

body,    which    are    symmetrical,    imply   an   origin   or 

pain. 
cause,  the  seat  of  which  is  central  or  bilateral  ;  while 

unilateral  pain  implies  a  seat  of  origin  which  is  one- 
sided, and,  as  a  rule,  exists  on  the  same  side  of  the 
body  as  the  pain. ' '  Every  pain  has  its  distinct  and 
separate  signification. 


48 

Fifteenth.  "The  same  trunks  of  nerves,  whose 
branches  supply  the  groups  of  muscles  moving  a  joint, 
furnish  also  a  distribution  of  nerves  to  the  skin  over 
the  insertions  of  the  same  muscles ;  and  the  interior 
of  the  joint  moved  by  these  muscles  receives  a  nerve 
supply  from  the  same  source." 

Sixteenth.  ' '  Every  fascia  of  the  body  has  a  muscle 
or  muscles  attached  to  it,  and  every  fascia  must  be 
considered  as  one  of  the  points  of  insertion  of  the 
muscles  connected  to  it. ' ' 

Seventeenth.  Steady  pressure  upon  the  terminal 
filaments  of  a  nerve  or  upon  the  course  of  the  nerve 
will  prevent  the  passage  of  impulses  along  the  nerve, 
thus  inhibiting  its  action.  Motion,  sensation,  reflexes, 
vaso-motor  effects  are  all  alike  affected ;  hence 
increased  activity  of  any  organ  is  reduced  to  the 
normal  by  pressure  on  the  nerves  of  the  organ.  The 
inhibitory  nerves  are  of  course  an  exception  to  this 
rule.  Pressure  upon  these  would  produce  no  effect  or 
else  increase  the  activity  of  the  organ  ;  the  effect 
being  dependent  upon  whether  the  nerves  were  in 
action  at  the  time. 

Eighteenth.  Activity  of  an  organ  may  be  aroused 
by  stimulating  the  functional  nerves  to  the  organ. 
Marked  variations  in  pressure  upon  any  portion  of  a 
nerve  will  stimulate  the  nerve.  Thus  the  osteopath 


49 

treats  a  nerve  to  arouse  its  activity  by  successive 
variations  in  pressure  rapidly  applied. 

Nineteenth.  The  points  along  the  nerves  where 
stimulation  will  be  most  effective  are  (i)  at  the 
periphery  of  the  nerve,  (2)  at  the  emergence  of  the 
nerve  from  the  spinal  canal.  Inhibition  is  likewise 
most  easily  accomplished  at  these  points. 

Twentieth.      A  stimulation  of  the  vaso-constrictor 

Vaso-motor 

nerves  of  an  organ  will  dimmish  the  amount  of  blood  effect  on 

capillaries. 

pressure  in  the  capillaries ;  their  inhibition  will  pro- 
duce the  opposite  result.  The  latter  is  the  condition 
in  inflammation  and  oedema — the  former  overcomes 
these  conditions. 

Twenty-first.  Head  has  found  that ' '  When  a  painful 
stimulus  is  applied  to  a  part  of  low  sensibility  in  close 
central  connection  with  a  part  of  much  greater  sensibility, 
the  pain  produced  is  felt  in  the  part  of  higher  sensibility 
rather  than  in  the  part  of  lower  sensibility  to  which  the 
stimulus  was  applied. ' ' 

Tactile  sensations  sometime  act  in  the  same  way  — 
a  transference  called  allochiria.  This  law  of  trans- 
ference of  effects  of  nervous  stimulation  may  be 
carried  further  and  applied  to  motion,  as  in  cases  from 
a  reflex  affecting  the  opposite  member ;  to  vaso-motor 
changes  and  to  all  forms  of  nerve  impulses.  Nor  is 
this  all.  Just  as  sensory,  motor  and  vaso-motor 


50 

impulses  may  be  transferred,  so,  too,  may  inhibition 
act  reflexly.  The  skin  and  muscle  of  a  spinal  segment 
are  supplied  by  afferent  nerves  from  the  same  central 
origin,  a  region  which  also  gives  origin  to  efferent 
nerves  going  to  some  one  or  more  of  the  viscera.  By 
pressure  on  these  sensory  fibres  we  check  the  deluge 
of  impulses  into  the  center  and  thereby  decrease 
the  chemical  changes  within  the  center  itself.  It  is 
upon  these  chemical  changes  that  the  nature,  quality 
and  quantity  of  the  outgoing  impulses  depend.  To 
reduce  these  to  the  normal  will  serve  to  restore  the 
organ  to  harmonious  relations.  This  is  a  fact  of 
fundamental  importance  in  our  treatment.  Our 
practice  shows  beyond  possibility  of  error  that  inhibi- 
tion of  the  periphery  of  one  branch  of  a  sensory  nerve 
will  reduce  the  expression  of  pain  in  other  branches 
of  the  nerve. 

Head's  law  is  a  statement  of  the  fact  upon  which 
we  base  many  of  our  diagnoses  by  spinal  examination. 
The  various  deductions  from  it  are  applied  in  treat- 
ment of  nearly  all  pathological  conditions. 

Twenty-second.       The    only    natural    and    rational 

Cure  depends 

cause.  method  of  treating  such  conditions  is  by  removal  of 

the  cause,  and  this  result  (except  in  cases  demanding 
surgical  interference)  is  perfectly  secured  only  by  such 
manipulation  as  will  overcome  all  interference  to  the 


51 

free  passage  of  the  efferent  and  afferent  impulses 
between  organ  and  center ;  and  by  stimulation  or 
inhibition  counteract  the  present  condition  of  innerva- 
tion  or  irritation,  thus  allowing  the  inherent  recupera- 
tive power  of  the  body  to  restore  to  normal  structure 
and  function  the  deranged  organ. 

Osteopathy  is  a  therapeutic  science  grounded  upon 
the  known  and  verifiable  laws  of  physiology  just 
enumerated.  From  those  principles  we  deduct  our 
definition  of  the  science.  Osteopathy  is  a  method  of  osteopathy 

defined. 
treating  disease  by  manipulation,  the  purpose  and  result 

of  which  is  to  restore  the  normal  condition  of  nerve 
control  and  blood  supply  to  every  organ  of  the  body  by 
removing  physical  obstruction,  or  by  stimulating  or 
inhibiting  functional  activity  as  the  condition  may 
require. 

By  the  term  physical  obstruction  we  mean  any  direct 
interference  to  the  nutritive  or  functional  fluids  or 
forces  of  the  organ,  as  pressure  upon  a  vessel  or  nerve 
by  an  abnormal  condition  of  some  denser  tissue  of 
the  body.  This  will  cut  off  the  nerve  force  and 
affects  the  blood  supply.  Either  of  these  may  result 
in  producing  an  abnormal  function  of  some  organ 
or  organs  and  thus  lead  to  a  diseased  condition. 

Osteopathy  achieves  its  chief  results  through  the 
nervous  system .  Nerve  action  may  be  influenced  : 


52 

First.  Through  the  centers  directly.  We  may  effect 
a  certain  nervous  control  of  the  abdominal  organs  by 
pressing  directly,  as  near  as  possible,  over  the  solar 
plexus.  Pressure  there  may  act  to  inhibit  the 
impulses  sent  out  from  that  center  which  are  pro- 
ducing pain  in  the  various  abdominal  organs. 

Second.  We  may  influence  nerve  action  through  the 
fibres.  We  do  this  in  various  ways.  We  may  affect 
the  fibres  by  removing  any  obstruction  to  the  nerve 
impulses  along  the  fibre,  or  we  may  affect  the  fibre  by 
stimulation,  not  by  removing  the  cover,  but  through 
the  medium  of  the  covering  structures,  putting  alter- 
nate pressure  upon  it  in  such  a  way  as  to  stimulate  it. 

Stimulation  is  a  broad  term  and  may  be  defined  as 
the  act  of  producing  or  increasing  functional  activity. 
The  methods  of  accomplishing  this  are  varied  ;  physi- 
ological or  natural,  mechanical,  thermal,  electrical 
and  chemical.  Of  these  the  first  or  physiological  is 
the  result  of  the  interaction  of  the  organs  and  the 
reaction  of  the  nervous  system  to  the  stimuli  of  the 
environments.  In  conditions  of  health  this  kind  is 
sufficient ;  in  response  to  it  the  heart  keeps  up  its 
rhythmic  throbbing,  the  glands  act,  the  various 
organs  perform  their  functions.  Each  increased 
strain,  within  limits,  produces  more  activity.  The 
skeletal  muscles  are  in  a  partial  state  of  contraction 


53 

called  skeletal  tone  in  response  to  a  continual  rain  of 
impulses  through  the  organs  of  touch,  temperature, 
sight,  smell,  the  muscular  sense.  While  this  is  true 
for  the  skeletal  muscles  it  is  eminently  the  case  in 
the  condition  known  as  arterial  tone.  Upon  those 
impulses  from  without  depend  the  healthful  state  of  the 
circulatory  system.  These  stimulations  are  continuous 
and  conducive  to  perfect  action.  The  air  stimulates 
the  skin,  it  reacts  upon  the  wall  of  the  alveoli,  the 
blood  causes  the  centers  of  the  organs  to  keep  up 
their  constant  outgoing  impulses.  The  second  and 
most  nearly  natural  in  its  effects  is  the  mechanical, 
the  mode  which  the  osteopath  uses  to  the  exclusion  of 
the  others  for  the  purpose  of  assisting  nature. 

Mechanical  stimulation  in  its  effects  is  similar  to 
physiological.  There  are  two  ways  by  which  the 
osteopath,  through  pressure,  affects  nerve  fibres.  One 
is  by  variation  in  the  degree  of  pressure,  producing 
stimulation.  The  other  by  continued  steady  pressure 
cutting  off  the  passage  of  impulses  along  the  nerve, 
thus  producing  inhibition,  Experience  shows  that 
steady  pressure  upon  a  nerve  will  produce  no  pain  or 
impulse,  even  though  carried  to  the  extent  of  crushing 
the  fibre  of  the  nerve.  We  will  now  define  inhibition 
as  an  act  which  restrains  or  retards  functional  activity. 
Inhibition  of  an  organ  may  be  produced  by  preventing 


54 

inhibition.  the  passage  of  impulses  to  it,  or  it  may  be  pro- 
duced (as  is  the  case  of  inhibitory  fibres  to  the  heart 
which  pass  through  the  vagus  nerve) ,  by  impulses  to 
the  organ  whose  effect  is  to  restrain  the  action  of  the 
organ.  The  osteopath  must  understand  this  double 
meaning  of  the  term  for  he  frequently  uses  both 
methods  of  producing  inhibition. 

This  question  now  presents  itself  to  us  :  In  what 
way  may  we  repress  or  excite  action?  Nervous 
tissue  controls  the  other  tissues.  It  is  by  nervous  con- 
nection that  the  organs  of  the  body  perform  their 
normal  function. 

Excitation  of  an  organ  may  be  perfectly  and  posi- 
tively secured  only  by  removal  of  obstructions  to  the 
free  passage  of  efferent  and  afferent  nerve  impulses  to 
the  organ.  It  is  clear  that  continued  steady  pressure 
upon  a  nerve  prevents  the  passage  of  impulses  through 
the  nerve.  This  would  produce  a  cessation  of  the 
normal  flow  of  these  impulses  to  the  organ,  as  is 
illustrated  by  constant  pressure  on  the  nerves  to  the 

Pressure  may     stomach.     But  it  might  have  two  effects.     If  it  were 
have  two 

perfectly  constant  the  pressure  would  have  the  effect 
of  restricting  the  normal  impulses  from  the  cerebro- 
spinal  center,  resulting  in  diminution  of  functional 
activity.  There  would  result  enervation  or  loss  of 
tone  of  the  organ,  tone  to  which  it  is  entitled.  Vary- 


55 

ing  pressure  will  increase  these  impulses,  thereby 
increasing  the  tone  and  activity  of  the  organ. 

Tone  is  that  healthy,  normal  state  intermediate 
between  complete  relaxation  and  contraction,  pro- 
duced by  a  summation  of  impulses  from  the  external 
world  sent  along  the  pathway  of  the  nerve  to  the 
central  nervous  system ;  and  there,  by  a  reflex 
mechanism  sent  out  to  the  muscles  which  are  con- 
trolled by  the  same  segment  of  the  cord.  Thus  we 
have  arterial  tone  as  a  result  of  reflex  mechanism  in 
continual  action.  It  is  a  state  of  partial  contraction 
characteristic  of  muscles  which  enter  into  the  struc- 
ture of  the  blood  vessels.  By  tone  or  tones  of  glands 
or  centers  we  mean  their  physiological  state  of  activity. 

These  facts  will  serve  to  illustrate  how  obstruction 
to  nerve  impulses  may  interfere  with  the  normal  func- 
tion of  the  organ  by  lessening  the  activities,  thus 
serving  as  an  inhibition. 

Physical  obstruction  or  interruption  may  interfere 
with  functional  activity  by  increasing  it.  If  steady 
pressure  in  any  way  becomes  a  varying  pressure,  how- 
ever slight,  that  would  result  in  a  constant  irritation 
to  the  nerves,  producing  impulses  exciting  the  organ 
to  unusual  activity  and  finally  to  a  pathological  condi- 
tion. So,  too,  by  interference  with  the  nutrition  of  a 
region  the  irritability  of  its  nerves  would  be  affected 


56 

and  a  changed  metabolism  result.  Again,  we  may 
remove  obstruction  which  serves  as  an  inhibition, 
resulting  in  a  stimulation.  Nerve  activity  is  basic 
to  the  activities  of  the  other  organs  of  the  body. 

Nerve  action  may  be  influenced  by  action  upon  the 
Nerve  activity 
basic.  centers  themselves.     A  physiological   or  true  center 

means  a  group  or  collection  of  nerve  cells  connected 
with  some  specific  organ  or  function  by  means  of 
afferent  and  efferent  fibres. 

Osteopathic  centers  are  entirely  different.     An  oste- 

OsteopatMc       opathic  center  is  a  practical  one.     By  the  term  we  do 
center  defined. 

not  necessarily  mean  a  local  group  of  cells  controlling 

function,  but  a  point  at  which  we  may  most  advantage- 
ously reach  the  nerves  or  cells  controlling  the  organ. 
To  illustrate  :  The  center  for  coughing  .is  near  the 
third  dorsal  vertebra  ;  there  is  not  at  that  point  in  the 
spinal  cord  a  group  of  cells  whose  function  it  is  to 
produce  coughing.  We  mean  that  there  are  entering 
that  region  afferent  nerve  fibres  whose  impulses  have 
been  transmitted,  resulting  in  a  muscular  contraction, 
giving  rise  to  a  cough.  By  removing  the  irritation 
thus  preventing  the  impulses  coming  from  that  peri- 
phery to  the  center,  we  have  treated  the  center. 

At  the  points  of  emergence  of  spinal  nerves  we  are 
able  to  obtain  more  satisfactory  results  than  at  any 
other.  Because  we  get  certain  results  by  treating  cer- 


57 

tain  spinal  nerves  we  cannot  assert  there  is  a  true 
physiological  center  at  that  level  in  the  cord.  Centers 
may  be  anywhere  so  far  as  treatment  is  concerned 
between  emergence  and  peripheral  ending  of  a  nerve. 
This  will  explain  wh^r  we  speak  of  centers  osteopath- 
ically  which  have  no  physiological  existence. 

We  stimulate  centers  by  treating  their  afferent  and  HOW  treated. 
efferent  nerve  fibres.  Our  effects  are  from  stimulation 
or  inhibition  along  the  pathway  of  the  nerve.  We 
may  further  stimulate  the  action  of  the  center  by 
stimulating  the  peripheral  distribution  of  the  sensory 
nerve.  We  will  go  farther :  We  are  able  to  treat 
directly  the  muscular  tissue  and  produce  contraction, 
or  inhibition  of  muscular  contraction.  In  this  we 
draw  our  conclusions  from  a  limited  number  of  cases. 
In  cases  of  perfect  anaesthesia  contracted  muscles  will, 
under  osteopathic  treatment,  relax  as  perfectly  as 
though  the  sensory  nerve  fibres  were  functioning. 
Whether  it  is  the  result  of  direct  stimulation  of 
the  muscle  is  a  question  we  cannot  answer  with 
certainty,  though  the  indications  are  to  that  effect. 
In  a  case  that  came  under  my  observation  the 
anaesthesia  was  so  complete  that  even  pressure 
upon  the  deeper  muscles  produced  no  sensation.  I 
argue  from  that  case  that  a  muscular  tissue  will  relax 


58 

on  treatment  when  not  connected  with  the  sensory 
fibres  as  readily  as  when  it  is. 

The  point  is  this  :  It  is  not  necessary  in  order  to 
produce  an  effect  upon  a  muscle,  particularly  if  that 
effect  be  relaxation,  to  stimulate  the  endings  of  the 
sensory  nerves  in  the  skin.  The  greater  part  of  our 
work  of  relaxation  is  accomplished  on  the  more  deeply 

lying  muscles.     Painful   stimulation  of  the    sensory 
Painful  treat- 
ment useless,      nerve  of  the  skm  produces  a  defensive  contraction  of 

the  muscle  underneath,  therefore,  the  best  results  are 
obtained  with  the  minimum  amount  of  pain.  To  this 
end  it  is  necessary  to  place  the  hands  gently  on  the 
integument  above  the  muscle  which  you  desire  to 
relax,  care  being  taken  to  use  the  flat  portion  of  the 
fingers.  Now  by  approximating  the  fingers  of  the  two 
hands  you  will  produce  a  fold  of  skin  between  them. 
Now  strong  pressure  will  produce  practically  no  sensa- 
tion of  pain  in  the  cutaneous  nerves.  If  this  pressure 
be  accompanied  by  a  separation  of  the  hands  the  effect 
of  relaxation  will  be  produced  on  the  contracted  mus- 
cles felt  beneath. 

I  will  here  emphasize  the  caution  just  expressed, 
that  you,  as  far  as  possible,  eliminate  the  use  of  the 
ends  of  the  fingers  in  treatment.  Since  it  often  happens 
that  your  first  treatments  are  directed  towards  over- 
coming headaches  and  therefore  administered  near  the 


59 

base  of  the  skull,  congestion  or  chronic  contraction 
sometimes  follow  from  the  application  of  too  much  force 
to  a  limited  space  beneath  the  ends  of  the  fingers. 
There  are  few  regions,  if  any,  which  yield  so  readily  to 
osteopathic  manipulation  as  the  neck.  There  is  no 
part  of  the  body  more  susceptible  to  injury  if  treatment 
be  incautiously  applied. 

We  are  able  to  inhibit  contraction  of  a  muscle  by 
osteopathic  treatment  applied  directly  to  the  muscle 
itself.  It  is  a  physiological  fact,  that  direct  application 
of  stimulation  to  a  muscle  itself  will  produce  contrac- 
tion. From  experience  we  say  we  can  overcome  a 
contracted  condition  of  a  muscle,  though  the  sensory 
nerves  are  not  in  any  way  affecting  it ;  e.  g. ,  in  case 
of  perfect  anaesthesia. 

Dr.  Schreiber    sums    up   the   effects    of  mechano-  Effects  of 

mechano- 

therapy  as  follows : 

First,  To  cause  an  increased  flow  of  blood  to  mus- 
cles and  soft  parts,  increasing  thereby  the  circulation, 
and  removing  accumulations  of  waste  tissues  whose 
retention  causes  various  disturbances  of  function. 

To  strengthen  muscle  fibres,  and  by  setting  up 
molecular  vibrations  to  induce  changes,  not  only  on 
the  muscle  and  nerve  fibres,  but  perhaps  even  in  the 
nerve  centers  themselves. 


60 

Second.  To  cause  the  resorption  of  exudations, 
transudations,  and  infiltrations,  in  such  organs  as  are 
accessible.  To  effect  the  separation  of  adhesions  in 
tendon  sheaths  and  in  joints,  without  recourse  to  the 
knife.  To  remove,  by  grinding  away,  intra-arthritic 
vegetations. 

Third.  To  increase  by  passive  and  active  exercise 
of  all  the  muscles,  the  oxidizing  powers  of  the  blood, 
in  this  way  correcting  disturbances  in  its  composition 
and  stimulating  all  the  vegetative  processes. 

Fourth.  To  relieve  the  congestion  of  such  internal 
organs  as  the  brain,  lungs,  intestines,  uterus,  kidneys, 
etc.,  by  increasing  the  flow  of  blood  to  the  muscles. 

Fifth.  To  stimulate  directly  the  sympathetic  nerv- 
ous system,  thus  increasing  secretion  and  reflexly  the 
activity  of  unstriped  muscle  fibre,  and  so  relieving 
various  functional  derangements. 


CHAPTER  III. 


SYMPATHETIC  NERVOUS  SYSTEM. 

THE  UNITY  apparent  in  the  structure  of  the 
nervous  system  is  evidenced  in  a  physiolog- 
ical unity,  harmony  and  interdependence  which  proves 
the  truth  of  the  statement  that  an  isolated  portion  of 
the  nervous  mechanism  does  not  exist  in  a  perfect 
individual.  Aside  from  the  central  nervous  system 
there  is  what  is  known  as  the  sympathetic  system. 
This  term  includes  the  following  distribution  :  To 
the  internal  viscera  ;  to  the  glands  outside  as  well 
as  within  the  hemal  cavity ;  to  the  vessels  as  vaso- 
motors,  and  to  the  hairs  as  pilo-motors.  Their  com- 
plete distribution  is  to  the  viscera,  vessels  and  to 
the  plain  muscle  fibres  generally.  But  this  distribu- 
tion to  the  plain  muscular  tissue  is  not  confined 
exclusively  to  the  sympathetic  system,  the  vagus  hav- 
ing extensive  visceral  distribution.  In  addition  to 
this,  many  fibres  from  spinal  nerves  have  visceral  con- 


62 

nection,  either  passing  through  the  sympathetic  gan- 
glia unchanged  or  not  entering  it. 

The  sympathetic  system  consists  of  a  collection  of 
ganglia,  nerve  trunks  and  plexuses.  The  ganglia 
contain  cells,  and  fibres  both  gray  and  white,  the 
latter  in  all  cases  connected  with  cells  within  the 
cerebro- spinal  system.  The  plexus  is  essentially  a 
network  of  fibres,  though  it  may  also  contain  cells. 
The  gray  fibres  are  truly  sympathetic,  having  their 
trophic  connection  with  the  cells  in  the  sympathetic 
system. 

With  these  extensive  ramifications  it  is  necessary 
that  there  be  a  varied  and  complicated  mechanism  ; 
hence  we  find  : 

First.  The  two  great  gangliated  cords  extending 
from  the  ganglion  of  Ribes  above,  connecting  the 
carotid  plexuses  via  the  anterior  communicating 
artery,  downward  to  the  coccyx  where  the  two  sacral 
chains  are  united  by  a  ganglion  (the  coccygeal,  or 
the  ganglion  impars),  situated  on  the  anterior  sur- 
face of  the  coccyx. 

Second.     The  great  prevertebral  plexuses. 

Third.  The  fibres  and  plexuses  of  distribution. 
[There  are  also  connected  with  the  cranial  nerves, 
ganglia  which  in  structure  and  connections  agree  with 
the  sympathetic  and  may  be  considered  as  a  part  of 


63 

this  system.]  The  first  of  these  groups,  the  great 
gangliated  cord,  consists  of  ganglia  connected  by 
short  cords,  the  ganglia  being  named  cervical,  dorsal, 
lumbar,  sacral,  etc.,  approximately  corresponding  to 
the  vertebrae,  except  in  the  cervical  region,  where 
the  segmental  arrangement  has  been  modified  by  a 
segregation  of  seven  into  three,  called  superior,  mid- 
dle and  inferior  cervical. 

The  foundation  of  the  sympathetic  system  is  consti- 

White  rami 

tuted  by  small,  white  fibres  from  the  cerebro-spinal 
system  through  certain  nerves  into  the  cords  and  gan- 
glia of  the  sympathetic.  These  constitute  the  white 
rami  communicantcs,  which  connects  the  cerebro-spinal 
and  sympathetic  portions  of  the  nervous  systems. 

They  come,  in  man,  from  the  first  thoracic  to  the 
second  lumbar,  inclusive,  being  both  afferent  and 
efferent  in  function.  In  the  sacral  region  the  homo- 
logues  of  the  white  rami  pass  directly  to  the  preverte- 
bral  plexuses  and  are  thence  distributed  to  the  pelvic 
viscera  as  splanchnic  divisions  of  the  sacral  nerves. 
There  are  no  white  rami  in  the  cervical  region.  The 
visceral  branches  of  the  third  nerve  (to  ciliary  gan- 
glion via  short  root),  of  the  seventh,  ninth,  tenth  and 
eleventh,  correspond  in  function  to  the  white  rami. 

White  rami  enter  the  sympathetic  either  at  the 
lateral  ganglia  or  at  the  cords  connecting  them,  and 


64 

may  come  from  both  roots  of  the  spinal  uerves. 
Those  of  the  posterior  root  are  from  the  spinal  gan- 
glia and  are  afferent  fibres.  Those  from  the  anterior 
are  efferent.  These  white  fibres  end  in  any  of  the 
following  ways  : 

First.  loosing  their  sheaths  in  the  lateral  ganglia, 
they  end  in  dendritic  brushes  within  the  lateral  ganglia. 

Second.  Some  pass  unchanged  through  the  lateral 
ganglia  to  the  prevertebral  plexuses  (white  rami  effer- 
entes),  or  they  may  continue  as  spinal  fibres  to  their 
distribution. 

Third.  The  fibres  of  the  white  rami  ending  in  the 
lateral  ganglia  may  branch  before  entering,  giving  off 
one,  two  or  three  collaterals,  thus  connecting  with 
several  ganglia. 

Fourth.  The  fibre  may  not  end  in  its  correspond- 
ing ganglion,  but  may  pass  to  ganglia  at  either  higher 
or  lower  levels. 

The  functions  of  the  white  rami  are  varied.  They 
transmit  all  the  impulses  from  the  cerebro-spinal  sys- 
tem to  the  sympathetic  ganglia  and  plexuses  and  vice 
versa.  This  work  is  done  by  those  which  end  within 
these  structures.  These  are  : 

First.  Vaso-constrictors,  from  anterior  roots,  end- 
ing in  lateral  ganglia. 


65 

Second.  Cardiac  augmentors,  ending  in  middle  and 
inferior  cervical  ganglia  and  in  first  thoracic. 

Third.  Viscero-motors  from  certain  spinal  nerves, 
also  the  corresponding  fibres  from  the  ninth,  tenth  ajid 
eleventh  cranial  nerves. 

Fourth.  Pilo-motor  fibres,  also  motor  nerves  to 
sphincter  of  iris  through  third  nerve. 

Fifth.  Secretory  fibres  to  the  sweat  glands  and  to 
the  glands  of  the  various  viscera. 

Sixth.  Viscero- inhibitory  fibres  also  end  in  this 
way,  though  in  some  cases  they  pass  directly  to  the 
viscera. 

Seventh.  Afferent  fibres  from  viscera  to  cerebro- 
spinal  center. 

In  addition  to  these  white  fibres  which  transfer  their 
impulses  to  the  sympathetic  and  are  succeeded  by  gray 
fibres,  the  vaso-dilator  fibres  pass  unchanged  to  the 
viscera,  though  some  seem  to  end  in  the  solar  plexus. 

Gray  rami 

Gray  rami  communicantes  connect  the  lateral  cord  with 
all  the  spinal  nerves.  They  are  ueuraxons  of  cells  tion- 
lying  in  the  lateral  ganglia,  usually  the  one  from 
which  they  make  their  exit  to  the  spinal  nerve,  though 
rarely  they  pass  upward  or  downward  through  the 
cord  to  the  succeeding  ganglion.  They  unite  with  the 
anterior  primary  division  of  the  spinal  nerves  and 
have  any  one  of  the  following  distributions  : 


66 

First.  Peripherally  to  the  distribution  of  the  ante- 
rior division  of  the  spinal  nerves,  —  to  their  muscular 
and  cutaneous  distribution. 

Second.      They    may  follow  the   anterior  division 
centrally  to  the  main  nerve  trunk,  whence  they  follow 
•  the  posterior  primary  division  to  its  distribution. 

Third.  Centrally  to  the  recurrent  branch  of  the 
spinal  nerve  and  with  it  to  the  wrappings  of  the  cord 
and  to  the  structure  of  the  cord  itself. 

Fourth.  Back  through  the  wrappings  of  the  pos- 
terior root,  to  the  dura  of  the  cord. 

The  first  and  second  vaso-constrictors  are  distributed 
to  the  vessels  of  the  skeletal  muscles  and  of  the  skin, 
secretory  to  the  sweat  glands,  and  pilo-motors  to  mus- 
cles of  the  hairs. 

The  third  and  fourth  are  vaso-motor  to  the  cord  — 
mainly  vaso-constrictors. 

In  addition  to  the  rami  communicantes  there  are  true 
sympathetic  fibres,  originating  in  the  lateral  ganglia, 
which  pass  forward  to  the  prevertebral  plexuses. 
With  these  are  medullated  fibres  which  have  passed 
through  the  lateral  ganglia,  together  constituting  the 
rami  cfferentes — the  gray,  sympathetic;  the  white, 
spinal. 

The  function  of  the  sympathetic  system  may  be 
stated  generally  as  follows  :  It  presides  over  the  move- 


67 
ment  of  the  plain  muscle  tissue,  nutrition  partially,   Functions  of 

the  sympa- 

secretion  usually,  general  sensibility  of  the  viscera,   thetlc- 
thermotaxis  and  vaso-motor  conditions.     When  dis- 
turbed reflexly  it  affects  one  viscus  from  another  and 
may  act  almost  independently  of   the  cerebro-spinal 
system  under  unusual  conditions. 

Specifically  the  functions  of  the  sympathetic  may  be 
classed  as  follows  : 

1.  Independent,    actions   which  continue  when  all 
connection  with  the  central  nervous  system  has  been 
destroyed  as  in  the  (a)  ganglia  of  the  heart,  (£)  the 
mesenteric  plexuses,  (c~)  the  plexuses  of  the  uterus, 
Fallopian  tubes  and  ureters. 

Even  these  are  modified  either  in  the  direction  of 
stimulation  or  inhibition  by  impulses  from  the  cerebro- 
spinal  system. 

2.  Dependent, — 

(a)  Afferent  impulses. 

(£)  Secretory  action  and  trophic. 

(V)  Vaso-motor. 

The  superior  cervical  ganglion  is  situated  on   the  superior 

cervical  gang- 

rectus  capitis  anticus  major  muscle  internal  to  the 
tenth  nerve  and  behind  the  internal  carotid  artery  at 
the  level  of  the  second  and  third  vertebra.  It  is  con- 
nected with  the  first  four  spinal  nerves,  and  with  the 
ninth,  tenth  and  twelfth  cranial  nerves.  This  ganglion 


68 

is  almost  an  inch  in  length  and  a  fourth  as  wide,  and 
is  of  great  importance  to  the  osteopath,  as  through  it 
he  controls  the  vaso-motors  to  the  head  and  face.  It 
is  continuous  above  with  the  carotid  and  cavernous 
plexuses  and  through  this  with  the  arteries  and  vessels 
of  the  brain.  Below  it  is  connected  with  the  middle 
cervical  ganglion  which  lies  opposite  the  sixth  or 
seventh  cervical  vertebra,  almost  at  the  level  of  the 
inferior  thyroid  artery.  Above,  this  ganglion  is  con- 
nected with  the  cavernous  and  carotid  plexuses  and 
through  these  gives  communication  to  the  sixth  nerve 
within  the  cavernous  sinus,  and  with  the  Gasserian 
ganglion  as  the  internal  carotid  artery  passes  through 
the  apex  of  the  petrous  portion  of  the  temporal  bone. 

The  cavernous  plexus  sends  filaments  into  the  third 
and  the  fourth  nerves,  thus  completing  the  control  of  the 
blood  supply  to  the  eye  and  its  motor  apparatus.  This 
fact  is  of  prime  importance  in  eye  trouble.  Osteopathic 
experience  proves  that  trouble  with  the  eye  is  asso- 
ciated with  a  lesion  in  the  upper  cervical  region,  located 
in  the  vast  majority  of  cases,  at  the  second  and  third 
vertebrae. 

The  reasoning  is  plain.  Here  is  the  pathway  of 
those  vaso-motor  impulses  to  its  nutrient  vessels,  and 
their  interruption  means  trouble  with  the  nutrition  and 
action  of  the  eye. 


69 

It  is  followed  upward  from  the  superior  cervical  to 
the  cavernous  plexus,  and  from  it  to  the  twig  following 
the  arteria  centralis  retinse  to  the  vessels  of  the  inner 
part  of  the  globe  of  the  eye.  The  same  pathway 
answers  for  those  fibres  which  control  the  muscles  of 
the  orbit,  differing  only  in  their  final  distribution. 

This  ganglion  controls  the  lumen  of  the  anterior 
pial  vessels  and  is  of  value  in  draining  the  cranial 
cavity  in  frontal  headache  due  to  congestion  and 
venous  stasis. 

The  large  deep  petrosal    branch,   the   sympathetic  Distribution 

from  Mechel's 

root  of  the  Vidian  nerve,  is  from  the  carotid  plexus  and 
through  this  channel  it  supplies  sympathetic  fibres  to 
Meckel's  ganglion  and  through  it  to  its  distribution  to 
the  orbit,  the  palate,  the  nose,  the  pharynx,  the 
antra,  ethnioidal  sinuses,  tonsils,  uvula,  etc. 

The  cavernous  plexus  lies  closely  associated  with 
the  carotid  plexus  in  the  cavernous  sinus  and 
sends  fibres  to  the  third  and  fourth  nerves, 
and  also  to  the  ophthalmic  division  of  the  fifth 
nerve  and  through  it  to  the  ciliary  ganglion. 
The  importance  of  this  ganglion  in  eye  trouble, 
epistaxis,  oedema  of  glottis,  pharyngitis,  laryngitis, 
sore  throat,  diphtheria,  croup,  etc.,  is  readily  seen. 
By  stimulating  the  ganglion  the  blood  vessels  of  these 
parts  are  constricted,  capillary  pressure  is  removed, 


70 

resorption  takes  place,  and  normal  secretion  and  action 
is  secured.  Again  this  ganglion  affords  more  direct 
connection  with  the  pharynx  than  through  the  spheno- 
palatine  ganglion,  for  it  gives  numerous  fibres  which 
following  the  blood  vessels,  are  distributed  with  the 
ninth,  tenth  and  eleventh  nerves,  forming  the  pharyn- 
geal  plexus.  Aside  from  this  the  superior  cervical 
ganglion  gives  off  a  branch  which  is  of  much  impor- 
tance in  contributing  to  the  great  cardiac  plexus. 

This  ganglion  controls  the  nutrition  of  the  muscles 
of  the  face,  the  action  of  the  mucous  and  salivary 
glands  and  even  contributes  to  nourish  the  fifth  nerve, 
the  great  sensory  nerve  of  the  head  and  face.  This 
will  make  plain  the  value  of  this  ganglion  in  diseases 
affecting  the  nerves  and  musics  of  the  face,  the  mucous 
tract  of  the  throat  with  its  adenoid  masses  beneath. 
This  ganglion  contains  a  large  number  of  cells  which 
mark  the  beginnings  of  the  fibres  going  to  the  distri- 
butions above  mentioned. 

The  middle  cervical  ganglion  is  situated  anterior  to 

Middle  cervical    ,  r  .,          .    ,,  .1  •      i 

the  transverse  process  of  the  sixth  or  seventh  cervical 
vertebra.  It  lies  near  the  inferior  thyroid  artery  and 
contributes  fibres  to  it  which  control  the  lumen  of  its 
branches  in  the  thyroid  gland.  It  is  associated  in 
function  with  the  superior  cervical  ganglion,  transmit- 
ting the  fibres  from  below  which  end  in  the  superior 


71 

cervical  ganglion.  These  fibres,  as  all  the  spinal  fibres 
in  the  cervical  sympathic,  come  from  the  dorsal  spinal 
nerves;  and,  as  white  fibres,  pass  up  to  the  ganglia  in  the 
cervical  region.  Ending  in  this  middle  cervical  gang- 
lion are  many  cardiac  augmeutor  fibres  which  have 
made  their  exit  from  the  cerebro-spinal  system  at  the 
second,  third  and  fourth  thoracic  nerves.  Beginning 
in  this  ganglion  are  the  fibres  which  constitute  the 
middle  cervical  sympathetic  cardiac  fibres,  and  which 
pass  down  into  the  thorax,  helping  to  form  the 
cardiac  plexus.  This  middle  ganglion  then  has  three 
uses.  In  manipulation,  steady  pressure  upon  it  will 
dilate  the  vessels  of  the  head  and  face,  will  retard 
slightly  the  action  of  the  heart,  will  dilate  the  vessels 
in  the  thyroid  glands.  Pressure  alternately  applied 
and  removed  will  have  the  opposite  effects.  This 
nerve  connects  with  two  cervical  nerves,  the  fifth  and 
sixth,  furnishing  vaso-motor  and  perspiratory  fibres 
to  them. 

The  inferior  cervical  ganglion  is  situated    between 
the  sides  of  the  seventh  cervical  vertebra  and  the  first  Inferior 

cervical 

rib  and  by  its  position  is  in  connection  above  with  the 
middle  and  superior  cervical  ganglia  and  below  with 
the  gangliated  cord.  Ofttimes  it  is  a  mass  united  to 
the  first  thoracic  and  corresponds  to  the  stellate  gang- 
lion in  the  lower  animals  —  either  the  first  thoracic  or 


72 

a  union  of  several  of  the  thoracic.  It  is  situated  over 
the  first  costo-central  articulation  between  the  vertebral 
and  the  subclavian  arteries  external  to  the  vertebral 
and  almost  behind  the  inferior  thyroid  artery.  It  is 
connected  to  the  middle  ganglion  by  a  cord,  passing 
behind  the  subclavian  artery.  This  cord  is  frequently 
double,  passing  both  behind  and  in  front  of  the  artery. 
This  anterior  cord  is  called  the  ansa  subclavian  or 
annulus  of  Vieussens.  It  sometimes  extends  from  the 
cord  below  the  middle  cervical  ganglion  to  the  lower 
cervical  or  to  the  first  thoracic.  This  annulus  is  much 
more  frequent  on  the  left  side  than  on  the  right  and  by 
its  contribution  to  the  cardiac  plexus  exerts  a  powerful 
influence  over  the  action  of  the  heart.  The  branches 
of  the  inferior  cervical  ganglion  are  :  i .  To  the  two 
lower  cervical  nerves  it  gives  vaso-motor  fibres.  2.  The 
inferior  cardiac  sympathetic  to  the  cardiac  plexus. 
3.  It  supplies  fibres  to  the  vertebral  artery  extending 
with  it  to  the  cranial  cavity  and  controlling  the  blood 
vessels  of  the  posterior  fossa  of  the  skull.  It  also 
sends  fibres  along  the  inferior  thyroid  artery  into  the 
thyroid  gland,  affecting  both  its  vessels  and  its  action. 
It  controls  the  internal  mammary  artery  and  the  comes 
nervi  phrenici  artery  from  this  vessel.  This  ganglion 
is  a  strong  point  of  attack  in  the  treatment  of  the  fol- 
lowing organs  and  diseases:  (i)  the  thyroid  gland 


73 

in  goiter;  (2)  the  circulation  —  sending  augmentor 
impulses  to  the  heart,  if  pressed  upon  sharply  and 
alternately;  (3)  it  has  an  effect  on  the  phrenic  nerves 
in  many  cases  of  asthma. 

The  cervical  sympathetic  receives  no  fibres  from  the 

sympathetics. 

cervical  nerves  but  receives  its  spinal  fibres  from  the 
dorsal  nerves.  It  contains  : 

(a)  Vaso-constrictor  for  head  from  second,  third 
and  fourth  dorsal. 

(b)  Augmentor  fibres  to  heart,  chiefly  from  second, 
third  and  fourth  dorsal. 

(c~)  Secretory  fibres  to  salivary  glands,  upper 
dorsal. 

(d)  Pupilo  dilator  and  motor  fibres  to  the  involun- 
tary muscles  of  eye  and  orbit. 

(tf)  Afferent  fibres  whose  stimulation  causes  activ- 
ity of  the  vaso- motor  center  in  the  medulla. 

The  thoracic  portion  of  the  gangliated  cord  consists 
of  two  cords  lying  on  either  side  of  the  vertebrae, 
within  the  hemal  cavity  and  connecting  above  and  tiwrac^18' 

sympathetics. 

below  with  the  cervical  and  the  lumbar  respectively. 
It  consists  of  eleven,  rarely  twelve,  ganglia  with  their 
connections,  corresponding  approximately  with  the 
costo-central  articulations,  though  in  the  case  of  the 
upper  one  or  two  and  the  lower  there  is  a  slight  failure 
to  correspond  to  theSe  positions.  The  branches  of 


74 

distribution  from  the  upper  four  or  five  are  given 
chiefly  to  the  corresponding  vertebrae,  their  ligaments 
and  to  the  descending  portion  of  the  thoracic  aorta. 
From  the  second,  third  and  fourth  branches  are  sent 
to  the  posterior  pulmonary  plexuses  which  gives  inner- 
vation  to  the  vessels  of  the  walls  of  the  bronchial 
tubes  and  of  the  bronchioles  within  the  substance  of 
the  lung  itself.  These  fibres  connect  within  these 
plexuses  with  the  fibres  from  the  pneumogastric, 
whence  are  furnished  the  motor  impulses  and  sensory 
fibres  to  the  walls  of  the  air  passages,  the  sympathetics 
affording  the  vaso-motor  fibres.  This  distribution 
explains  why  the  ' '  centre ' '  for  the  lungs  is  said  to 
be  in  the  upper  dorsal  region  ;  and  also  the  philosophy 
of  our  treatment  for  such  conditions  as  bronchial 
troubles,  emphysema,  pneumonia,  tuberculosis  of  the 
lung  and  kindred  affections.  This,  then,  is  what  the 
osteopath  calls  the  centre  for  the  lungs  located 
at  the  second,  third  and  fourth  dorsal.  From  the 
lower  dorsal  ganglia  beginning  at  the  fifth  or  sixth 
are  given  fibres  to  form  three  large  nerves,  the 
splanchnics,  or  the  abdominal  splanchnics  of  Gaskell, 
which  are  of  wide  distribution  to  the  abdominal 
viscera,  being  transmitted  in  three  separate  and  dis- 
tinct trunks,  the  great,  the  small  and  the  smallest 
splanchnics.  The  great  splanchnic  takes  origin  from 


75 

the  fifth  to  the  tenth  dorsal  ganglion  inclusive,  and 
may  be  traced  upward  to  the  third  or  even  the  second 
thoracic  ganglion,  and  passing  downward  through 
the  crus  is  distributed  to  the  setnilunar  ganglion  and 
through  it  to  the  renal  and  suprarenal  plexuses. 
Some  of  the  fibres  of  this  nerve  are  truly  sympathetic 
fibres,  while  the  majority  are  medullated  fibres  from 
the  spinal  cord.  The  small  splanchnic  comes  from 
the  ninth  and  tenth,  or  the  tenth  and  eleventh  and 
follows  in  the  pathway  of  the  great  splanchnic  and  is 
distributed  to  the  solar  plexus  and  sometimes  on  the 
plexus  to  the  kidney  —  the  renal  plexus.  The  small- 
est splanchnic  comes  from  the  eleventh  ganglion,  or 
from  the  region  corresponding  to  the  twelfth  thoracic 
vertebra  and  its  distribution  is  to  the  kidney.  The 
term  splanchnic  should  be  used  to  include  all  nerves 
whose  distribution  is  to  the  various  viscera,  but  the 
more  restricted  use  of  the  term  has  limited  it  to  the 
nerves  mentioned  and  we  shall  follow  the  general  use 
of  the  term. 

A  summary  of  the  functions  of  the  thoracic  sympa- 
thetic is  useful  : 

1.  Augmentor      fibres    to    cardiac     plexus    from 
second,  third  and  fourth. 

2.  Vaso-constrictors   to   the   lungs,    second,   third 
and  fourth. 


76 

3.  Certain  afferent  fibres  whose  stimulation  results 
in  cardie-inhibitory   action  in   the  medulla,  sixth  to 
tenth. 

4.  The  splanchnics  contain  vaso-constrictor  fibres 
to    abdominal    vessels    and    other    plexuses    of    the 
abdomen. 

5.  The  secretion  of  the  intestinal  glands. 

6.  Secretory  to  sweat  glands. 

7.  Vaso-constrictor  for  arms,  upper  sixth  dorsal  ; 
for  legs,  lower  dorsal  and  second  lumbar. 

8.  Viscero-inhibitory  fibres  to  stomach  and  intes- 
tines.    The  motor  fibres  of  the  intestinal  tract,  except 
the  rectum,  are  from  the  vagus. 

In  the  lumbar  portion  of  the  gangliated  cord  there 
are  usually  four  small  oval  ganglia  closely  situated 
in  front  of  the  bodies  of  the  lumbar  vertebrae 
along  the  inner  margin  of  the  psoas  muscle.  On  the 
right  side  the  cord  is  under  cover  of  the  vena  cava,  on 
the  left  it  is  beneath  the  aorta.  The  branches  con- 
necting the  spinal  nerves  with  the  ganglia  accompany 
the  lumbar  arteries  and  are  covered  by  the  fibrous 
bands  from  which  the  fasciculi  of  the  psoas  muscle 
originate. 

These  ganglia,  with  their  branches,  connect  with 
the  plexus  around  the  aorta ;  some  fibres  reach 
the  hypogastric  plexus  and  through  it  the  pelvic 


77 

plexus,  others  going  to  the  ligaments  and  vertebrae 
within  the  lumbar  region.  Descending  from  the 
thoracic  cord  to  the  lumbar  we  find  fibres  having 
almost  the  same  function  as  the  thoracic  sympathetic. 
In  the  lumbar  sympathetic  we  find  viscero-inhib- 

LumJjar 

itors  to  the  descending  colon  and  rectum,  vaso-con- 
stricter  to  the  pelvic  viscera,  to  lower  abdominal 
vessels.  These  are  from  lower  dorsal  and  first  and 
second  lumbar.  From  this  source  come  the  vaso- 
constrictors to  legs  ;  vaso-constrictors  to  penis,  first 
and  second  lumbar  to  hypogastric  plexus,  thence  via 
pudic  nerve  as  gray  fibres.  Motor  fibres  to  bladder, 
upper  lumbar.  Motor  fibres  to  uterus,  first  and 
second  lumbar.  Motor  fibres  to  vas  deferens  (male), 
round  ligament  (female),  first  and  second  lumbar. 

The  sacral  sympathetic  is  diminished  in  size,  consist- 
ing of  a  variable  number  of  ganglia,  usually  four, 
joined  below  by  a  loop  on  which  is  the  ganglion 
impars  (the  coccygeal  ganglion).  This  portion  of  the 
sympathetic  sends  fibres  to  the  pelvic  plexus,  others 
to  the  plexus  on  the  sacral  artery,  to  the  ligaments, 
to  the  coccyx  and  to  the  coccygeal  gland.  There 
are  no  fibres  passing  into  the  lateral  ganglia  from  the 
sacral  nerves,  these  being  supplied  from  the  lumbar 
cord  above. 


78 

The  visceral  branches  of  the  sacral  nerves  are 
equivalent  to  white  rami.  They  pass  at  once  to  the 
pelvic  plexuses  or  to  the  pelvic  viscera. 

Because  of  this  direct  relation  between  the  visceral 
branches  of  the  sacral  nerves  and  the  somatic  divis- 
ions, the  pelvic  viscera  respond  very  readily  to  sacral 
manipulations.  In  the  sacral  region  we  find  : 

1.  Motor  fibres  to  rectum. 

2.  Motor  fibres  to  bladder. 

3.  Vaso-dilators  to  penis  —  nervi  erigentes. 

4.  Secretory  fibres  to  prostate  gland. 

There  are  three  prevertebral  plexuses  — the  cardiac, 
solar  and  hypogastric,  each  of  which  has  connections 
with  and  subdivisions  in  minor  plexuses  which  are  to 
be  regarded  as  prolongations  of  the  sympathetic  along 
the  blood  vessels. 

The  cardiac  is  a  plexus  deriving  fibres  directly  from 

the  vagi  and  the  cardiac  branches  of  each  of  the  three 

Formation  of    cervical  ganglia  referred  to  above.     It  is  divided  into 

cardiac  plexus. 

two  portions  ;  superficial  plexus  just  anterior  to  the 
aortic  arch,  and  deep  cardiac  plexus  situated  behind 
the  aorta  anterior  to  the  end  of  the  trachea  and 
above  the  bifurcation  of  the  pulmonary  artery. 

The  superficial  is  derived  from  the  superior  cervical 
branch  of  the  sympathetic  and  from  the  lower  cervical 
cardiac  branch  of  the  pneumogastric  on  the  left  side. 


79 

The  deep  cardiac  plexus  is  formed  by  all  the  cardiac 
branches  from  the  cervical  sympathetics,  except  the 
superior  cervical  cardiac  on  the  left  side  and  the  infe- 
rior cardiac  branch  of  the  pueumogastric  of  the  left 
side.  From  this  plexus  fibres  extend  along  the  pul- 
monary vessels  to  form  the  greater  part  of  the  anterior 
pulmonary  plexus,  being  assisted  in  this  work  by  a 
few  fibres  from  the  anterior  pulmonary  branches  of 
the  tenth  nerve.  The  posterior  pulmonary  branches 
of  the  vagus  unite  with  the  fibres  from  the  second, 
third  and  fourth,  sometimes  also  the  first  thoracic 
ganglia,  and  forms  the  posterior  pulmonary  plexus 
which  is  distributed  to  the  substance  of  the  lung, 
including  the  muscles  to  the  air  tubes  and  the  vaso- 
motors  to  the  various  tissues  of  the  organ.  Here,  too, 
fibres  are  given  off  which  form  plexuses  on  the  coro- 
nary arteries  of  the  heart.  From  this  plexus  we  find 
fibres  going  to  the  heart  and  to  the  lungs,  the  great 
organs  of  circulation  and  respiration.  The  fibres  are 
from  the  vagus,  and  through  the  cervical  ganglia  form 
the  second,  third,  fourth,  and,  perhaps,  first  and  fifth 
thoracic  ganglia.  It  is  for  this  reason  that  such  a 
large  part  of  osteopathic  treatment  is  directed  to  these 
two  regions,  the  cervical  and  the  upper  dorsal. 

The  functions  of  the  fibres  in  this  plexus  are  :  Aug- 
mentor  fibres  to  the  heart,  vaso-constrictors  to  the 


80 

coronary  arteries  (through  vagus),  vaso-constrictors 
to  the  pulmonary  and  bronchial  blood  vessels,  sensory 
fibres  to  the  pleura  and  lungs,  first  to  fifth  dorsal ; 
sensory  fibres  to  heart  and  pericardium,  second  to 
fifth  dorsal.  The  sympathetic  fibres  may  be  reached 
at  the  middle  or  inferior  cervical  ganglion  at  which 
point  steady  pressure  will  retard  the  rate  of  heart- 
beat, and  dilate  the  pulmonary  arterioles.  The  same 
effect  is  produced  by  relaxing  contracture  in  the 
interscapular  region.  By  this  treatment  the  heart  is 
strengthened  in  two  ways  ;  resistance  in  lung  is  re- 
moved, and  rate  of  beat  is  retarded. 

Pain  in  pleura,  pericardium,  lungs  or  heart  may  be 
assuaged  by  pressure  applied  in  the  interscapular 
region  —  first  to  sixth  dorsal. 

From  the  pneumogastric  the  cardiac  plexus  receives 
fibres  to  the  heart,  depressor,  inhibitory,  vaso-con- 
strictor,  motor  or  constrictor  fibres  to  the  bronchioles, 
sensory  fibres  to  the  mucous  lining  of  the  air  tubes. 

The  solar  plexus,  which  on  account  of  its  complex 
connections  and  size,  Byron  Robinson  calls  the 
"  abdominal  brain,"  lies  on  the  aorta  just  back  of  the 
stomach  in  the  interval  between  the  points  of  origin  of 
the  phrenic  and  renal  arteries,  practically  surrounding 
the  origin  of  the  coeliac  axis  and  the  great  mesenteric 
artery.  From  this  great  ganglionic  mass  there  are 


81 

numerous  branches  given  off  accompanying  the  aorta 
and  its  divisions  to  all  the  abdominal  viscera,  forming 
secondary  plexuses  named  after  the  arteries  along 
which  they  pass  :  cceliac,  superior  mesenteric,  supra- 
renal, renal,  spermatic,  aortic,  etc. 

This  plexus  is  formed  of  fibres  from  the  great 
splanchnics,  the  lesser  splanchnics  and  from  the  right 
pneumogastric.  The  least  splanchnic  enters  chiefly  into 
the  formation  of  the  renal  plexus  controlling  the  kid- 
ney. These  fibres  are  from  the  fifth  to  ninth  or  tenth 
thoracic  ganglia  and  are  the  vaso-motor  fibres  to  the 
stomach,  intestines  and  glands  of  the  abdomen, 
viscero-inhibitory  fibres  to  the  stomach  and  intestines, 
and  secretory  to  the  glands  connected  with  alimentary 
tract.  In  addition  the  splanchnics  carry  the  impulses 
of  general  sensibility  and  pain.  The  vagus  contributes 
to  this  plexus  viscero-motor  impulses  which  through 
it  reach  the  stomach  and  intestine  as  far  down  as  the 
sigmoid  flexure ;  sensory  fibres  from  the  mucous  lin  - 
ing  are  carried  by  the  vagus.  The  vagus  is  the  motor 
nerve  to  all  portions  of  the  stomach  —  fundus  and 
pyloric  portion  including  the  sphincter  pyloric. 

The  solar  or  epigastric  plexus  continues  downward   , 

Subsidiary 

as  strands  of  fibres  on  either  side  of  the  aorta,  cross  formed  from 

solar. 

the  common  iliac  arteries  and  form  a  plexus  lying  in 
front  of  the  lowest  lumbar  vertebra.  Into  this  plexus 


82 

enter  the  fibres  from  the  adjacent  lumbar  ganglia  form- 
ing the  hypogastric  plexus.  From  this  are  formed 
chiefly  the  various  plexuses  which  are  distributed  to 
the  pelvic  organs.  The  pelvic  plexuses  lying  by  the 
side  of  the  rectum  serve  as  relays  from  the  hypogastric 
and  are  increased  by  spinal  branches  from  the  third 
and  fourth  sacral  nerves,  rarely  by  the  second. 

The  fibres  from  this  plexus  differ  in  their  distribu- 
tion with  the  sex,  but  we  should  ever  remember  that 
in  the  female  we  get  the  fibres  through  the  lower  lum- 
bar and  sacral  region  to  the  vagina,  uterus,  ovary  and 
tubes,  and  in  man  to  the  corresponding  organs. 

Again  from  this  source  fibres  are  distributed  to  the 
bladder  and  rectum  —  facts  of  peculiar  interest  to  us 
in  the  many  cases  of  bladder  trouble,  constipation  and 
piles.  The  fibres  to  the  vagina  and  to  the  bladder  are 
peculiarly  rich  in  the  continuation  of  the  spinal 
branches  from  the  sacral  nerves. 

The  functions  of  the  hypogastric  plexus  briefly  are 

Function  of  .    .   .  ,    .          .  ,  .. 

hypogastnc       these :    vaso-constnctor  to  pelvic   viscera  from  aortic 

plexus. 

plexus  and  from  upper  lumbar  ganglia ;  viscero- 
inhibitor  from  lumbar  to  rectum  ;  viscero-motor.  The 
hypogastric  plexus  contributes  vaso-constrictor  and 
viscero-inhibitor  fibres.  Through  the  hypogastric 
plexus  pass  sensory  impulses  from  the  pelvic  viscera. 


83 

The  sacral  nerves  furnish  to  the  pelvic  plexuses, 
motor  nerves  to  haetnorrhoidal  plexuses  of  rectum, 
motor  nerves  to  the  vesical  plexus  controlling  the 
walls  of  the  bladder,  sensory  and  motor  fibres  to 
bladder  pass  from  second  and  third  sacral,  some  sen- 
sory passing  into  hypogastric  plexus  and  out  to  lumbar 
ganglia.  The  lower  portion  of  the  ureter  is  supplied 
by  these  nerves  as  well  as  the  vas  deferens  and  the 
vesiculae  seminalis.  The  prostatic  plexus  receives  its 
vaso-constrictor  fibres  from  the  first  and  second  lumbar 
via  the  white  rami  to  lumbar  ganglia,  thence  to  pelvic 
plexus. 

The  vaso-dilator  fibres  to  this  plexus  from  the  second 
and  third  sacral  —  the  nervi  erigentes.  These  nerves, 
the  visceral  or  splanchnic  branches  of  the  sacral 
nerves,  do  not  pass  into  the  sympathetic  ganglia,  but 
pass  to  the  plexuses  and  to  the  viscera  direct.  From 
the  prostatic  plexus  they  pass  to  the  erectile  sub- 
stance of  the  penis  as  the  cavernous  nerves,  where 
they  mingle  with  sensory  fibres  from  the  pudic. 

The  vagina  receives  fibres  from  the  second  and  third 
sacral,  both  motor  and  vaso-dilator.  Stimulation  of 
these  serve  as  constrictors  of  the  vagina,  and  produces 
turgescence  of  the  vulva.  The  uterus  is  supplied 
almost  exclusively  by  fibres  from  the  hypogastric 
plexus.  From  this  source  it  receives  vaso-constrictor 


84 

and  viscero-dilator  fibres.  Constrictor  fibres  to  the 
neck  of  the  uterus  pass  to  it  from  the  first  and  second 
sacral.  Its  sensory  fibres  are  through  the  hypogastric 
plexus  and  the  lumbar  nerves,  chiefly  the  second  and 
third. 


ACCOMPANYING    DORSAL 

ROOT  TO  DURA     ^«  DORSAl    SPINAL 
NERVE  ROOT 


=_      TO  VEHT-EBft/t    LIGAMENTS, 
E?=^"  SPINAL  VESSELS  4  DURA 


SOMATIC  vASOMOTOR, 
PILOMOTOR,  SECRETORV 


VISCERAL  FIBRES 

MEOufLATEO  FIBRES  PASSING  THROUGH  THE 

GANGL>ON  TO  PREvERTEBRAL  PLEXUSES 

OR  DIRECTLY  TO  VISCERA. 

.{^SYMPATHETIC   TRUNK 

Wl 

t  d»  TFROM  LOWER  GANGLIA 


FROM  RAMU8  COMMUN. 
TO  VERTEBR/E  AND 
INTERCOSTAL  AND 
LUMBAR  VESSELS. 


TO  LOWER  GANGLIA 

PLAN  OF  A   LATERAL  GANGLION    OF  THE    SYMPATHETIC   CORD 
AND   ITS   CONNECTIONS. 

Medullated  fibres  represented  by  continuous  lines,  non-medullated 
fibres  by  interrupted  lines. 

— (From  Gerrish's  Anatomy .) 


CHAPTER    IV. 


VASO-MOTORS. 

IN  A  WORK  explaining  the  laws  of  physiology 
upon  which  the  science  of  Osteopathy  rests,  the 
vaso-motor  nerves  contributing  as  they  do  a  powerful 
influence  to  the  circulation  of  the  blood,  are  entitled 
to  a  full  consideration.  These  fibres  are,  in  their 
effect,  of  two  kinds  :  vaso-constrietors  or  those  whose 
activity  decreases  the  lumen  of  the  blood  vessels,  and 
vaso-dilators  whose  activity  dilates  the  arterioles, 
increasing  their  lumen. 

This  vaso-motor  control  is  primarily  a  function  of  y^  V(180_ 

motor  center. 

the  cerebro-spmal  system  and  is  associated  with  certain 
cells  situated  in  the  medulla  or  bulb,  a  more  or  less 
diffuse  center  lying  on  either  side  of  the  median  line. 
This  bilateral  center  seems  to  be  associated  with  the 
antero-lateral  nucleus  of  Clark  and  it  may  be  that 
these  cells  are  the  center  for  the  vaso-motors.  That 
there  is  a  center  for  vaso-dilator  impulses  in  the 


86 

medulla  has  never  been  proven,  so  we  shall  treat  this 
center  as  if  wholly  vaso-constrictor  in  function.  It  is 
constantly  in  action  producing  tonic  or  hypertouic 
effects.  The  dilators  act  locally  and  irregularly 
producing  hypotonic  effects.  In  addition  to  the 
general  vaso-constrictor  center  there  are  subsidiary 
centers  located  at  varying  levels  of  the  spinal  cord. 
These  are  true  vaso-motor  reflex  centers.  Again 
there  are  vaso-motor  reflexes  in  the  sympathetic 
centers.  These  centers  control  the  rhythmic  activity 
of  many  vessels  of  the  body  during  health. 

The  vaso-dilators  are  not  proven  to  have  any  general 

.  ,  _  1t 

center,  but  are  supposed  to  come  from  centers  or  cells 
located  in  different  levels  of  the  cerebro- spinal  axis. 
The  dilators  then  are  only  local  in  their  action,  the 
vaso-constrictors  are  both  local  and  general. 

The  dilators  make  their  exit  from  any  portion  of  the 
cerebro-spinal  axis.  The  constrictors  pass  from  but  a 
limited  portion- of  it  —  that  portion  lying  between  the 
second  dorsal  and  the  second  lumbar  inclusive. 

All  the  vaso-dilators  are  medullated  fibres  until 
their  distribution  to  the  vessels.  They  may  pass 
through  the  sympathetic  ganglia,  in  which  case  they 
continue  through  it  as  white  rami  efferentes.  They 
may,  on  the  other  hand,  pass  from  the  cord  with  the 
anterior  nerve  root  or  their  homologues  in  the  brain 


87 

and  with  it  enter  into  the  spinal  nerves,  following 
chiefly  the  motor  fibres  to  be  distributed  to  the  blood- 
vessels of  the  muscle  supplied  by  the  nerve. 

The  vaso-dilators  are  spinal  nerves  and  lose  their   va»o- 

coiistrictors. 

sheaths  only  on  the  vessels  whose  walls  they  effect. 

The  vaso-constrictors  also  begin  as  spinal  nerves, 
connected  directly  or  medially  with  the  cells  in  the 
bulbar  vaso-motor  center,  and  they  make  their  exit 
from  the  spinal  cord  as  medullated  fibres  through 
the  anterior  roots  of  the  spinal  nerves  from  second 
dorsal  to  second  lumbar  and  run  as  white  rami 
communicantes  to  the  ganglia  of  the  lateral  chain. 
They  never  leave  the  chain  as  medullated  fibres  but 
may  pass  either  upward  or  downward  in  the  chain 
before  losing  their  sheath  in  the  ganglia.  An  example 
of  this  is  seen  in  the  vaso-motors  of  the  head,  face, 
etc. ,  which  emerge  from  the  spinal  cord  in  the  second , 
third  and  fourth  spinal  nerves,  and  entering  the 
gangliated  cord  pass  upward  to  the  superior  cervical 
ganglion,  in  which  they  end. 

From  the  lateral  ganglia  all  the  vaso-constrictor 
impulses  are  carried  over  pale  or  sympathetic  fibres. 
These  may  follow  in  their  distribution  any  of  the 
pathways  of  the  gray  rami  communicates  (Chap.  Ill, 
page  65)  or  they  may  pass  directly  to  the  viscera  or 


88 

indirectly    as     gray     rami     efferentes    through    the 
prevertebral  plexuses  to  the  viscera. 

The  osteopath  uses  the  vaso-motor  nerves  perhaps 
more  often  than  any  other  nerves  of  the  body.  Aside 
from  these  there  has  never  been  any  unequivocal  proof 
of  the  existence  of  trophic  nerves  and  they  are  in 
function  closely  associated  with  secretion.  Their 
disturbance  interferes  with  the  function  of  every  gland 
and  tissue  in  the  body.  The  effects  of  their  activity 
are  twofold,  local  and  general.  The  action  of  the 
vaso-constrictors  tends  to  increase  the  resistance  to  the 
blood  passing  from  the  arteries  into  the  capillaries  and 
into  the  veins.  This  effect  will  increase  the  work 
thrown  upon  the  heart.  This  effect  will  be  propor- 
tionate to  the  degree  of  constriction  and  the  area 
affected.  Its  maximum  effect  would  be  produced  if 
the  whole  arterial  area  were  affected.  Its  minimum 
effect  is  witnessed  when  a  small  area  is  affected.  The 
increased  amount  of  work  may  be  counter-balanced  by 
the  action  of  a  nerve  which  runs  within  the  vagal 
sheath  —  the  depressor  nerve  —  a  nerve  which  conveys 
sensory  impulses  from  heart  to  vaso-motor  center, 
which  impulses  diminish  arterial  tone  in  other  parts 
of  the  organism,  chiefly  through  the  inhibition  of  the 
vaso-constrictors  of  the  abdominal  splanchnics. 


89 
Now   the  effect  of    vaso-dilatation   is  exactly  the  Effect  of  vaso- 

dilatation. 

opposite  of  constriction  —  a  diminution  of  blood 
pressure  everywhere.  The  general  fall  will  be 
proportional  to  the  area  dilated  and  the  amount  of  the 
dilatation.  But  in  local  dilatation  the  most  marked 
effect  will  be  a  flushing  of  the  capillaries  of  the  dilated 
area.  Just  so  in  local  constriction  the  most  noticeable 
effect  will  be  the  pallor  of  the  constricted  area. 

These  changes  produce  one  effect  upon  the  pressure 
in  the  capillaries,  another  in  the  small  arteries  and 
arterioles.  To  appreciate  this  it  is  necessary  to 
remember  that  the  capillary  walls  consist  of  plates  or 
cells  very  sparsely  wrapped  with  connective  tissue  but 
containing  no  muscle  fibres  and  therefore  having  no 
vaso-motor  control.  These  cells  are  capable  of 
expansion  and  of  elastic  recoil. 

The  change  in  the  lumen  of  the  capillary  is  a 
passive  one.  When  the  firm  and  muscular  walls  of 
the  arterioles  are  contracted  they  receive  the  pressure 
of  the  blood  and  resist  its  surging  forward  into  the 
capillaries.  While  the  pressure  against  the  walls  of 
the  arterioles  has  remained  unchanged  the  capillaries 
have  received  much  less  blood  and  therefore  are,  by 
the  innate  elasticity  of  the  epithelioid  plates  much 
reduced  in  lumen.  During  dilatation  of  the  arterioles 


Constriction 
decreases 
capillary 
pressure. 


Facts  per- 
taining to 
vaso-nwtors. 


90 

the  lateral  pressure  of  the  blood  must  be  resisted  by 
the  capillaries,  hence  they  are  distended. 

To  put  it  briefly,  constriction  of  the  arterioles 
decreases  capillary  pressure;  dilatation  of  the  arterioles 
increases  capillary  pressure. 

Now  the  vaso-constrictor  center  is  in  continual 
action  resulting  in  arterial  tone.  Any  increase,  either 
general  or  local,  is  called  hypertonic  ;  any  decrease  is 
a  hypotonic  condition.  Arterial  tone  is  the  result  of 
the  condition  of  the  blood  which  stimulates  the  vaso- 
motor  center  and  of  the  general  relation  between  the 
thermogenic  and  thermolytic  centers  and  the  summa- ' 
tion  of  stimuli  which  stimulate  the  sensorium  from 
without.  These  conditions  are  further  affected  by  the 
action  of  the  augmentor  and  the  depressor  fibres 
regulating  the  strength,  rapidity  and  rhythm  of  the 
heart-beat.  Any  stimulation  of  a  sensory  nerve  will 
increase  the  action  of  the  vase-motors. 

There  are  a  few  well  known  facts  upon  which  our 
treatment  is  based : 

First.  The  cervical  sympathetics  contain  afferent 
fibres  which  when  stimulated  excite  the  vaso-motor 
center  in  the  medulla. 

Second.  There  is  an  inverse  relation  between  the 
vessels  of  the  skin  and  the  deeper  parts  on  reflex 
stimulation  of  the  vaso-motor  centers. 


91 

Third.  The  vaso-constrictors  are  distributed  chiefly 
to  the  viscera  and  to  the  cutaneous  vessels.  The 
vaso-dilators  chiefly  to  the  skeletal  muscles  and  to 
some  other  local  structures  and  glands. 

Fourth.  Vaso-motor  actions  may  be  inhibited  by 
pressure.  Cutting  off  the  impulses  which  would 
enter  the  center  may  allay  the  outgoing  ones. 

Fifth.  Usually  the  rate  of  heart-beat  and  arterial 
pressure  vary  inversely,  a  low  peripheral  resistance  is 
accompanied  by  a  rapid  pulse. 

Sixth.  In  addition  to  the  general  bulbar  center 
there  are  subsidiary  centers  controlling  the  vaso-motor 
condition  of  the  various  viscera. 

Our  theory  of  controlling  the  vaso-motor  condition 
of  the  body  locally  and  generally  is  as  follows  : 

First.  By  pressure  upon  the  inferior  cervical 
ganglion  we  decrease  the  rate  of  the  heart-beat ;  this 
decrease  is  followed  by  a  reflex  vaso-constriction. 

Second.  By  varying  the  pressure  put  upon  the 
splanchnics  the  mesenteric  vessels  are  constricted 
and  a  reverse  condition  prevails  in  the  cutaneous 
capillaries.  This  is  an  important  point  in  thermotaxis; 
it  serves  to  regulate  the  temperature  by  irradiation 
and  by  evaporation  of  the  product  of  the  perspiratory 
glands. 


Thermngenic 
center. 


Vaso-motor 
centers  for 
organs. 


92 

Third.  Steady  pressure  at  the  basi-occiput  is 
usually  considered  as  holding  the  vaso-motors.  What 
is  done  is  to  reduce  by  mechanical  pressure  the  blood- 
flow  to  the  brain,  to  quiet  the  irritated  meningeal 
nerves  and  to  reduce  the  pressure  in  the  arterial  twigs 
which  nourish  the  vaso-motor  center.  This  stimulates 
the  over-fatigued  center  to  healthy  action,  increases 
arterial  tone,  and  reduces  rate  of  heart  -  beat  by 
diminishing  impulses  from  the  augmentor  center 
situated  near  the  vaso-motor  center  in  the  medulla. 

Fourth.  The  thermogenic  center  is  located  in  the 
corpus  striatum.  Pressure  on  the  vertebral  artery 
aided  by  downward  pressure  on  the  carotid  sheath 
will  send  less  blood  to  this  center,  aid  in  its  drainage 
and  thus  reduce  temperature.  The  splanchnics  must 
be  stimulated  at  the  same  time  to  aid  in  thermolysis. 

The  following  are  the  vaso-motor  centers  for  the 
various  organs,  members  and  viscera  : 

Head  :     The  superior  cervical  ganglion. 

Throat,  tonsils,  nose,  etc.,  are  reached  at  the  same 
point. 

Dilators  for  tongue  and  mucous  membrane  :  Fifth 
and  ninth  cranial  nerves. 

Eye :  Superior  cervical  ganglion  through  fifth 
n  erve. 


93 

Brain,  anterior  and  middle  fossae  :  Superior  cervical 
ganglion.  Posterior  and  middle  fossae :  Inferior 
cervical  ganglion. 

Muscles  of  neck  :     The  three  cervical  ganglia. 

Thyroid  gland :  Middle  and  inferior  cervical 
ganglia. 


PLAN  OF  AN    UPPER    DORSAL    NERVE,    SHOWING   THE   TYPICAL 

MANNER   OF    BRANCHING  OF  THE  ANTERIOR  AND 

POSTERIOR   PRIMARY  DIVISIONS   OF  A 

SEGMENTAL  NERVE. 

—(From  Quain's  Anatomy). 

All  of  the  above  make  their  exit  at  the  first  to 
fifth  dorsal  vertebra,  hence  any  lesion  in  this  or  the 
cervical  region  may  affect  any  of  these  regions. 


94 

Heart :  The  vagi.  We  obtain  effects  on  nutrition  of 
heart  at  the  middle  and  inferior  cervical  by  inhibition. 

I,ungs  :     From  second  to  sixth  dorsal. 

Liver :     The  splanchnic  area,  sixth  to  tenth. 

Intestines :  Fifth  dorsal  to  second  lumbar,  a 
segmental  supply  in  the  order  duodenum,  jejunum, 
ileum,  colon. 

Kidneys  :     Tenth  to  twelfth  dorsal. 

Spleen  :  Ninth  and  tenth  dorsal.  Vagus  contracts 
spleen  through  its  action  on  muscular  trabeculae. 

Portal  system  :     Fifth  to  tenth  dorsal. 

External  generative  organs,  constrictors  :  First  and 
second  lumbar  to  sympathetic  and  to  hypogastric 
plexus,  thence  through  pelvic  plexuses  or  through 
pudicnerve. 

Dilators  :  First  and  second  sacral  via  nervi  erigentes 
to  pelvic  plexuses. 

Internal  generative  organs  (both  sexes) :  First  and 
second  lumbar. 

Arm,  vaso-constrictors  :  Second  and  seventh  dorsal. 
Vaso-dilators  chiefly  in  motor  nerves  of  the  muscles. 

I/eg  :  Constrictors,  sixth  dorsal  to  second  lumbar. 
Dilators  in  sheaths  of  motor  nerves. 

Trunk  :  Constrictors,  at  corresponding  segments. 
Dilators,  in  motor  nerves  to  muscles  usually. 


CHAPTER  V. 


OSTEOPATHIC  CENTERS. 

work  of  the  osteopath  is  in  many  cases 
palliative  —  always  in  acute  cases  and  usually 
as  preparatory  treatment  in  chronic  conditions  it  is 
necessary  to  reduce  muscular  contraction.  This 
muscular  contraction  is  in  many  cases  a  reflex  effect 
of  stimulation  of  branches  of  afferent  nerves,  other 
branches  of  which  are  distributed  to  the  muscles  of  the 
spine.  According  to  Head's  law  (Chap.  II,  page  49) 
these  contractions  are  the  result  of  changed  conditions 
in  the  viscus.  To  remove  these  will  restore  the 
normal  circulation  to  the  organ  through  vaso-motor 
effects  and  tend  to  restore  the  organ  to  health.  This 
contraction  is  reduced  by  steady  pressure  applied  to 
the  muscles  of  the  back,  usually  the  deeper  layers. 
The  point  at  which  this  produces  the  most  marked 
effect  is  between  the  spines  and  the  transverse 
processes.  The  pressure  should  be  directed  upward, 


96 

outward  and  forward.     Quain  gives  the  sensory  nerve 
supply  to  the  various  viscera  as  follows  : 

Heart :     First,  second  and  third  dorsal. 

Lungs  :     First,  second,  third,  fourth  and  fifth  dorsal. 

Stomach  :  Sixth,  seventh,  eighth  and  ninth  dorsal. 
Cardiac  end  from  sixth  and  seventh.  Pyloric  end  from 
ninth. 

Intestines  :  (a)  Down  to  upper  part  of  rectum,  ninth, 
tenth,  eleventh  and  twelfth  dorsal,  (b)  Rectum, 
second,  third  and  fourth  sacral. 

Liver  and  Gall-bladder :  Seventh,  eighth,  ninth 
and  tenth  dorsal. 

Kidney  and  Ureter  :  Tenth,  eleventh  and  twelfth 
dorsal.  Upper  part  of  ureter,  tenth  dorsal.  At  lower 
end  of  ureter,  first  lumbar  tends  to  appear. 

Bladder :  (a)  Mucous  membrane  and  neck  of 
bladder,  second,  third  and  fourth  sacral  ;  (£)  over 
distention  and  ineffectual  contraction,  eleventh  and 
twelth  dorsal  and  first  lumbar. 

Prostate  :  Tenth,  eleventh,  (twelfth)  dorsal,  first, 
second  and  third,  and  fifth  lumbar. 

Bpididymis  :  Eleventh  and  twelfth  dorsal,  and  first 
lumbar. 

Testis  :     Tenth  dorsal. 

Ovary  :     Tenth  dorsal. 


97 

Appendages,  etc.:  Eleventh  and  twelfth  dorsal, 
first  lumbar. 

Uterus :  (a)  In  contraction,  tenth,  eleventh  and 
twelfth  dorsal  and  first  lumbar,  (b)  Os  uteri  ;  (first) 
second,  third  and  fourth  sacral  (fifth  lumbar  very 
rarely). 

Osteopathy  bases  its  claim  to  rank  as  a  science  of 
healing  upon  the  fact  that  there  exists  a  definite  and  system. 
fixed  relation  between  an  organ  and  the  central  nervous 
system.  This  relation  is  secured  through  the 
segmented  arrangement  of  the  spinal  nerves  or  through 
the  sympathetic  system,  by  means  of  rami  communi- 
cantes.  The  order  of  this  inner vation  is  fairly  constant, 
though,  as  is  the  case  with  other  portions  of  the  body, 
it  may  vary.  This  variation  in  no  wise  invalidates 
the  claim  of  osteopathy  to  rank  as  a  science,  but  it  does 
emphasize  the  necessity  of  our  searching  for  lesions 
even  in  regions  relatively  remote  from  the  center. 
Specific  treatment  in  the  sense  of  work  exclusively 
upon  a  region  said  to  be  a  center  is  rarely  indicated. 
Owing  to  the  diffusion  of  pain  and  its  attendant  con- 
ditions, it  is  necessary  to  remove  any  contracture  which 
may  be  associated  with  it.  Again  it  sometimes  occurs 
that  disease  of  an  organ  produces  no  effect  on  its  usual 
center,  and  in  such  an  event  it  is  necessary  to  carefully 
examine  other  regions  for  the  trouble.  A  case  of  con- 


98 

gested  ovary  was  recently  related  to  me  in  which  there 
was  no  soreness  in  the  usual  center,  eleventh  dorsal, 
nor  would  persistent  treatment  directed  to  this  center 
produce  any  effect,  while  a  marked  lesion  was  found 
at  the  sacro-iliac  synchondrosis  and  the  removal  by 
treatment  resulted  in  restoring  the  normal  condition. 
Know  the  location  of  the  centers.  Know  also  that 
occasionally  a  lesion  causing  the  trouble  must  be  found 
elsewhere.  ' '  Touching  the  button  "  is  a  fascinating 
method  of  treating,  both  in  theory  and  in  practice,  but 
the  operator  must  be  broad  enough  to  expect  it  to  be 
difficult  occasionally  to  locate  the  button. 

Reminding  you  again  that  our  use  of  the  term  cen- 
ter is  in  the  sense  of  a  convenient  and  advantageous 
place  to  reach  fibres  to  or  from  a  certain  organ,  we 
shall  point  out  some  of  the  more  prominent  and 
important  centers : 

The  atlas  is  associated  with  disturbances  to  the  vaso- 
motors  of  the  eye,  ear,  and  with  eczema  and  other 
diseases  of  the  face. 

The  axis  and  third  cervical  is  a  general  vaso-motor 
center,  the  superior  cervical  ganglion,  center  for  side 
of  head,  face,  eye,  nose,  pharynx,  tonsils  and  vessels  of 
the  brain. 

Third,  fourth  and  fifth  cervical,  origin  of  phrenics, 
center  for  hiccoughs. 


99 

Fifth  and  sixth  cervical,  middle  cervical  ganglion  ; 
center  for  thyroid  gland  ;  also  augmentors  to  heart 
through  middle  cervical  ganglion. 

The  general  function  of  the  cervical  region  is  that 
of  (i)  vaso- constrictor  effect  through  sympathetic 
fibres  passing  into  it  from  below  through  the  second, 
third,  fourth  and  fifth  dorsal,  and  vaso- dilator  fibres  in 
the  cervical  spinal  nerves,  thus  affecting  all  parts  of  the 
body ;  and  (2)  local  vaso-motor  effects  on  the  neck, 
head  and  face  of  the  same  side.  That  the  upper 
cervical  region  is  sometimes  said  to  be  a  center  for  the 
kidney  is  based  upon  its  influence  over  the  general 
vase-motors  of  the  entire  body. 

Second,  third,  fourth,  fifth  and  sixth  dorsal  are  vaso- 
constrictors to  the  pulmonary  blood  vessels. 

Third  to  seventh  dorsal,  vaso-motors  to  arm  via  the 
brachial  plexus. 

Seventh  cervical  and  first  dorsal,  inferior  cervical 
ganglion,  heart,  thyroid  gland,  vertebral  and  basilar 
arteries. 

Annulus  of  Vieussens  and  second,  third,  fourth  and 
fifth  dorsal,  augmentory  fibres  to  the  heart. 

The  first  three  give  regularity  of  rhythm. 

Fourth  and  fifth  control  intermittency  and  regularity 
of  heart-beat. 


100 

Fourth  dorsal,  sometimes  third  or  fifth,  stomach 
center  on  right  side  usually.  General  effect  as  low  as 
the  eighth. 

Second  and  third  dorsal  center  for  ciliary  muscle, 
also  muscle  of  eye.  Center  for  vomiting. 

Sixth  to  tenth  dorsal,  origin  of  the  great  splanchnic, 
carrying  viscero-inhibitory  fibres  and  viscero-con- 
strictor  and  secretory  fibres  to  the  stomach  and  small 
intestine. 

Eighth,  ninth  and  tenth  dorsal  on  right  side,  center 
for  the  liver.  This  gives  us  the  center  for  chills,  as 
the  liver  and  spleen  are  implicated  in  malarial  attacks. 

Ninth  and  tenth  dorsal  on  the  left,  center  for  the 
spleen.  In  treatment  of  chills  the  general  condition 
must  be  controlled  through  cardiac  and  vaso-motor 
centers,  directing  especial  attention  to  the  liver  and 
spleen.  Also  center  for  uterus  via  hypogastric  plexus. 

Eleventh  and  twelfth  dorsal  and  upper  lumbar,  the 
small  intestine  and  kidney. 

Eleventh  and  twelfth  dorsal,  center  for  ovary. 

Second  lumbar,  center  for  parturition,  micturition 
and  uterus. 

Second,  third  and  fourth  lumbar,  center  for  diarrhoea. 

Fourth  and  fifth  lumbar,  hypogastric  plexus,  which 
with  fibres  from  the  aortic  plexus  forms  the  pelvic 
plexus  distributing  fibres  to  the  pelvic  organs. 


101 

The  anterior  division  of  the  sacral  nerves  are 
splanchnic  in  function  and  are  distributed  to  the 
rectum,  to  the  bladder,  sphincter  ani,  vagina  and 
uterus.  These  seem  to  be  chiefly  viscero-motor  in 
function. 

Second  and  third  sacral,  bladder. 

Fourth  sacral,  vagina. 

Fourth  and  fifth  sacral,  sphincter  ani. 

After  a  general  view  of  the  centers  along  the  spine 

Control  of 

it  is  necessary  to  form  a  resume  of  their  location  by  circulatwn 
mentioning  the  chief  organs  of  the  body  and  with 
them  the  regions  in  which  they  may  be  affected 
through  their  vaso-motor  and  viscero-motor,  inhibitory 
and  secretory  nerve  supply.  Generally  speaking  the 
circulation  is  controlled  through  the  great  vaso-motor 
centers,  reached  in  the  upper  cervical  region.  It  is 
further  controlled  through  the  region  from  which  the 
augmentor  fibres  make  their  exit  —  the  second  to  the 
fifth  dorsal.  It  is  also  affected  by  treatment  in  the 
splanchnic  region  controlling  the  vaso-motors  to  the 
great  capillary  network  of  the  mesenteries. 

That  the  respiratory  activity  is  closely  affected  by 
the  circulation  is  known  to  everyone,  so  a  treatment 
affecting  the  one  in  a  measure  modifies  the  other.  So 
far  as  is  known  there  is  no  center  for  voluntary 
motion  other  than  the  exit  of  the  motor  nerves  along 


102 

the    spine.       (The    physiological    center    is    in    the 
encephalon. ) 

A  spinal  lesion  may  cause  a  paralysis  of  all  the 
motor  apparatus  below  that  lesion,  or,  if  the  lesion 
affect  a  small  area  of  the  cord  transversely,  its  effect 
may  be  limited  to  a  few  muscles  or  to  a  few  groups  of 
muscles  in  a  region  whose  motor  nerves  pass  through 
the  affected  region. 

Nutrition  is  likewise  dependent  upon  respiration, 
circulation  and  the  condition  of  the  stomach, 
intestines,  liver,  etc.,  so  a  center  for  nutrition  is 
consequently  not  to  be  sought  for  in  any  one  region. 

The  practical  value  of  the  foregoing  facts  is  this : 
If  the  symptoms  indicate  trouble  or  disturbance  of  a 
certain  organ,  look  carefully  for  lesions  in  the 
corresponding  spinal  center.  Should  other  symptoms 
not  permit  of  a  differential  diagnosis,  as  is  often  the 
case,  then  the  existence  of  a  lesion  at  the  center  for 
an  organ  will  be  an  almost  infallible  evidence  of 
disease  of  that  organ. 

In  case  of  a  disturbance  in  any  of  the  following 
organs  or  members  look  for  your  spinal  lesions  as 
follows  : 

Pharynx,  larynx  and  tonsils:  Second  and  third 
cervical. 


103 

Thyroid  gland :     Fifth  and  sixth  cervical;    general  center  for 

thyroid  gland 

vaso-motor  and  cardiac  center,  seventh  cervical  and 
first  dorsal  —  head  of  first  rib  ;  clavicle. 

Arm,  motion,  vaso-motor  and  nutrition  :  Brachial 
plexus  in  fifth,  sixth,  seventh,  eighth  cervical  and  first 
dorsal.  Also  vaso-motors  in  third  to  seventh  dorsal. 

Lungs  and  bronchi :  Second  to  sixth  or  eighth 
dorsal ;  also  vagus  nerve. 

Heart  :  Fibres  from  second  to  fifth  dorsal,  special 
attention  to  fifth  dorsal.  Heart  may  also  be  reached 
through  middle  and  inferior  cervical  ganglion,  and  at 
first  rib,  or  annulus  of  Vieussens. 

Stomach :  Third  to  fifth  dorsal  specific  on  right 
side,  third  to  eighth  generally  ;  also  vagus. 

Liver  :  Ninth  and  tenth  dorsal,  vaso-motor,  vagus 
motor. 

Spleen :  Eighth  to  eleventh  dorsal,  vaso-motor, 
vagus  motor. 

Duodenum  :   Great  splanchnic,  sixth  to  tenth  dorsal. 

Jejunum  and  ileum  :  Lower  dorsal  and  lumbar  to 
fourth  and  fibres  from  solar  plexus. 

Colon  :  Second  to  fifth  lumbar.  Also  fibres  from 
solar  plexus. 

Rectum :  Second  to  fifth  lumbar  via  inferior 
mesenteric  plexus,  inhibitory.  Sacral,  via  hypo- 
gastric  plexus,  motor  ;  also  third  and  fourth  dorsal. 


104 

In  the  treatment  of  the  abdominal  viscera  in  addition 
to  the  specific  treatment  it  is  always  beneficial  to  give 
direct  treatment  to  the  abdomen,  paying  particular 
attention  to  the  region  of  the  solar  plexus.  This  has 
the  effect  of  changing  the  blood  by  sheer  compression, 
thus  relieving  venosity  and  allaying  increased  peris- 
talsis ;  or  in  case  of  sluggishness  of  any  organ  it 
stimulates  the  plexuses  of  Auerbach  and  Meissner ,  to 
motion  and  secretion.  It  may  also  break  up  masses  of 
fecal  matter  lying  within  the  abdominal  canal. 

Uterus  :  Second  to  fifth  lumbar,  ninth  and  tenth 
dorsal. 

Genitalia  generally :     Second  to  fifth  lumbar. 

Bladder  :     Second,  third  and  fourth  sacral. 

Sphincter  ani :     Fifth  sacral. 

The  knowledge  of  the  location  of  these  centers  is  of 
incalculable  advantage  to  the  osteopath  since  it  is 
upon  this  knowledge  that  the  accuracy  of  his  treat- 
ment depends,  and  since  so  much  of  the  osteopaths' 
success  is  dependent  upon  the  accuracy  of  his 
diagnosis  this  must  be  available  knowledge.  An 
osseous  lesion  in  the  area  which  we  have  designated  as 
a  center  for  a  certain  organ  may  lead  to  a  diseased 
condition  of  that  organ  ;  while  a  lesion  of  an  organ 
may  manifest  itself  in  tenderness  within  its  center 


105 

along  the  spine.     This  tenderness  may  be  found  in  the 
following  localities  : 

1.  On  the  ends  of  the  spinous  processes,  usually 
indicating  an  anterior  condition. 

2.  Above  the  spinous  processes  and  about  an  inch 
lateral  at  the  articulation  of  the  rib  with  the  transverse 
process  of  the  vertebra,  indicating  a  lateral  movement 
and    often    a    tipping   forward   of   the  body  of   the 
vertebra. 

3.  The  soreness  may  be  manifested  at  the  angle  of  Location0f 

tenderness. 
the  rib,  indicating  a  rotation  of  the  rib  upward  or 

downward  on  the  axis  connecting  its  two  extremities. 

4.  Associated  with  any  of  these  three  conditions 
may  be  found  soreness  in  the  muscles  lying  in  that 
region  on  either  side  of  the  spinous  process. 

To  determine  these  conditions  the  patient  should  be 
sitting. 

Gentle  pressure  will  determine  any  sensitiveness. 
To  examine  the  angles  of  the  ribs  in  the  interscapular 
region  the  arm  on  the  same  side  should  be  grasped  at 
the  elbow  and  firmly  passed  across  the  chest.  This 
will  tighten  the  muscles  and  expose  the  rib  from  the 
covering  of  the  scapula.  In  all  these  cases  the 
muscular  contraction  must  be  released  ;  to  do  this  the 
patient  should  be  placed  upon  the  table  and  a  firm  and 
steady  pressure  applied  to  the  muscles,  the  skin  being 


106 

lax,  passing  either  upward  or  downward.  This  will 
release  the  pressure  and  may  be  sufficient  in  acute 
cases.  In  addition  to  this,  an  oscillation  of  the  body 
from  side  to  side  bending  at  the  lesion  will  prove 
helpful,  as  will  rotation  around  the  same  point. 
Springing  the  spine  forward  will  produce  a  good 
effect  by  releasing  muscular  and  ligamentous  con- 
tractures. 


CHAPTER  VI. 


THEORY  OF  THE  TREATMENT  OF  THE  SPINE. 

SINCE  so  large  a  part  of  our  treatment  is  directed 
toward  the  seat  of  the  trouble  via  the  spinal 
nerves,  it  is  necessary  that  we  defend  ourselves  and 
our  science  by  rationally  explaining  the  modus  curandi 
of  osteopathic  manipulations.  It  is  necessary  to  recall 
to  mind  the  relation  of  the  central  nervous  system  to 
the  sympathetic  through  the  rami  communicantes,  and 
also  the  function  of  the  sympathetic  in  distributing 
secretory,  nutritive,  sensory  viscero- motor  and  vaso- 
motor  impulses.  Leaving  out  all  disputed  points  we 
take  the  primary  facts  upon  which  all  physiologists 
and  anatomists  are  practically  agreed,  viz.  : 

(1)  That  from  the  entire  length  of  the  cerebro- 
spinal  center  vaso-dilator  fibres  make  their  exit. 

(2)  That  the  vaso-constrictors  are  confined  in  their 
exit   to  the   region   of   the  cord   lying   between   the 
second  dorsal  to  the  second  lumbar  inclusive. 


Non-aerated 
blood  an 
stimulat  to 
peristalsis. 


108 

(3)  That  the  viscero-motor  go  largely  through  the 
vagus  nerve  to  the  stomach  and  intestines. 

(4)  That   the   sympathetics   are   the  great    vaso- 
constrictor and   viscero-inhibitors  to    the    solar    and 
related  plexuses. 

(5)  Sensory  fibres  from  the  viscera  pass  through 
the  sympathetics  to  the  spinal  nerves. 

(6)  Inhibition  of  nerve  action   may   be  procured 
reflexly.     Pressure  on  one  branch  of  the  nerve  will 
quiet  pain  in  other  branches. 

(7)  The  motor,  vaso-motor  and  secretory  conditions 
of  a  viscus  are  controlled  by  the  condition   of   the 
nerve  center  controlling  that  organ  ;    hence  affecting 
the  sensory  nerve  affects  the  viscus. 

It  is  necessary  to  remember  that  non-aerated  blood 
is  the  greatest  stimulant  to  peristalsis ;  pain  and 
cramping  are  often  only  an  evidence  of  increased 
peristalsis. 

Any  change  in  the  blood  supply  to  the  stomach  and 
intestine  has  its  direct  effect  upon  the  nutrition  of  the 
body,  influencing  both  digestion  and  absorption  ;  also 
it  has  its  effect  on  excretion  through  the  kidneys. 
Thus  it  is  plain  that  the  region  that  controls  nutrition 
and  excretion  is  of  vast  importance  in  regulating  the 
general  welfare  of  the  organism. 


Dr.  L.  Hart's  theory  was  as  follows:     "Through  Dr. Hart's 

theory. 

stimulation  of  vase-motors  distributed  to  the  vessels 
in  the  muscles  along  the  spine  we  produce  a  constric- 
tion of  these  peripheral  vessels  which  thus  increases 
the  pressure  in  the  collateral  branches  of  these  arteries, 
increasing  the  pressure  of  the  blood  in  the  vessels 
within  the  cord  itself. ' ' 

This  treatment  is,  according  to  Dr.  Hart's  theory, 
directed  toward  regulating  the  blood  supply  to  the 
nerve  cells  within  the  spinal  cord,  and  through  over- 
coming hypersemia  or  anaemia  of  the  center  restore 
normal  functioning  to  both  nerve  and  organ  with 
which  it  is  anatomically  connected. 

Another 

Another  theory  which  seems  much  more  in  accord  theory. 
with  our  immediate  results  obtained  in  acute  cases  or 
in  giving  immediate  relief  to  exacerbations  of  pain  is 
here  given. 

Our  theory  is  this  :  First,  we  inhibit  the  passage  of 
afferent  impulses  by  pressure  on  the  posterior  sensory 
portions  of  spinal  nerves.  This  reduces  the  impulses 
sent  in,  quieting  the  pain  by  quieting  the  center.  We 
reduce  muscular  contractions  which  have  irritated  both 
efferent  and  afferent  fibres  to  the  viscera.  These  con- 
tractions have  caused  a  venous  stasis  in  the  capillaries 
of  the  muscles  themselves  irritating  the  posterior  sen- 
sory nerves  which  reflexly  affect  the  viscera. 


110 

We  remove  irritation  from  the  vaso-constrictors 
allowing  normal  blood  supply  to  be  re-established.  We 
stretch  the  connective  tissue  and  take  off  pressure  from 
the  nerve  trunks.  We  equalize  the  nerve  tension  be- 
tween center  and  periphery. 

In  order  to  appreciate  this  theory  it  is  necessary 
to  grasp  the  philosophy  of  transferred  or  sympa- 
thetic pains.  This  is  a  fact  long  known  to  the  med- 
ical profession  though  poorly  utilized  by  them  in 
diagnosing  disease.  Investigations  by  Head  prove 
that  in  diseases  of  internal  organs  manifestations  of 
this  condition  will  be  made  by  tenderness  in  widely 
removed  parts,  the  diseased  organ  and  the  region 
manifesting  the  tenderness  having  a  fixed  relationship. 
Thus  toothache  may  cause  pain  in  the  ear,  heart 
trouble  may  cause  a  localized  pain  between  the 
shoulders,  kidney  trouble  manifests  itself  by  pain  in 
the  back.  Careful  investigation  will  reveal  the  fact 
that  the  soreness  is  not  in  most  instances  associated 
with  the  skin  alone  but  that  the  tenderness  is  found 
in  the  muscles  beneath.  Head  explains  the  topo- 
graphical association  of  tenderness  with  visceral 
disorders  by  the  assumption  that  the  nerves  supplying 
the  regions  thus  related  have  their  origin  within  the 
same  segment  of  the  spinal  cord.  The  viscera  are 
regions  of  low  sensibility  while  the  skin  and  muscles 


Ill 

are  more  freely  supplied  with  sensory  fibres  and  may 
be  called  regions  of  high  sensibility.  The  sensory 
result  of  visceral  irritation  or  lesion  is  summarized 
thus  :  ' '  When  painful  stimulus  is  applied  to  a  part  of 
low  sensibility  in  close  central  connection  with  a  part  of 
much  greater  sensibility,  the  pain  produced  is  felt  in 
the  part  of  higher  sensibility  rather  than  in  the  part  of 
low  sensibility  to  which  the  stimulus  was  actually 
applied."  This  law  is  proved  both  by  experiment  and 
clinical  practice.  But  clinical  observation  further 
shows  that  the  converse  of  that  proposition  is  true. 
Constant  irritation  or  stimulation  in  a  region  of  high 
sensibility  in  close  central  connection  with  a  viscus 
will  produce  both  functional  and  structural  disturbance 
in  the  viscus  as  well  as  sensitiveness  in  the  region 
stimulated.  That  such  stimulation  exists  cannot  be 
doubted.  Trauma  ma}'  produce  slips  or  minor 
dislocations.  Anaemia  allows  a  relaxation  which  will 
favor  such  conditions.  Cold,  constant  labor,  over- 
work, general  excitement  may  produce  muscular 
contractions  which  often  remain  permanent.  Thus 
osseous,  ligamentous  or  muscular  pressure  may  serve 
as  a  stimulus,  which,  having  its  first  effect  on  a 
region  of  high  sensibility,  will  soon  manifest  itself  in 
some  irregularity  of  the  organ.  Then  the  radical 
treatment  will  be  to  remove  the  irritation  by  over- 


112 

coming  muscular  contraction,  or  pressure  upon  the 
nerve  from  whatever  source.  That  a  muscle  devoid 
of  irritation  may  be  made  to  contract  is  a  simple 
physiological  fact  easily  proven.  That  steady  pressure 
accompanied  by  a  stretching  motion  forcibly  applied 
to  a  contracted  muscle  will  cause  it  to  relax  is  also 
proven  in  osteopathic  practice  daily.  Again  it  is  a 
physiological  axiom  that  prolonged  stimulation  of  a 
nerve  causes  it  to  fail  to  function  ;  hence,  irritation  of 
a  nerve,  the  result  of  contracture,  ultimately  causes 
loss  of  tone  to  and  function  of  the  organ  supplied  by 
that  nerve, —  or,  in  other  words,  prolonged  stimulation 
serves  to  inhibit. 

In  conditions  of  anaemia  of  an  organ,  contraction 
of  muscles  and  tenderness  of  superficial  nerves  coming 
from  corresponding  segments  of  the  cord  are  always 
found. 

Now,  our  chief  object,  if  the  foregoing  statements 
are  correct,  is  to  relieve  contracture,  and  whether  the 
condition  be  one  of  anaemia  or  hypersemia  the  removal 
of  this  condition  will  allow  a  restoration  of  the  normal 
condition.  This  explains  why  one  often  obtains 
the  same  result  from  a  stimulating  treatment  as  from 
an  inhibitory  one. 

The  case  is  markedly  different  in  the  cervical  region 
where  one  may  apply  direct  stimulation  or  inhibition 


113 

to  the  sympathetics  and  to  the  vagus  for  the  heart  and  Direct  effect  in 

cervical  and 
viscera  sacral  regions. 

It  is  also  different  in  the  sacral  region,  for  there  you 
work  on  the  posterior  division  of  the  sacral  nerves 
while  the  anterior  division  is  splanchnic  in  function 
and  distribution,  thus  allowing  a  more  direct  effect 
without  any  intervention  of  the  sympathetics. 

First.  We  correct  osseous  lesions  which  have 
interfered  with  any  of  the  classes  of  nerves  to  the 
disturbed  viscus. 

Second,  Immediate  effects  are  produced  by 
reducing  muscular  contractures  which  have  irritated 
the  somatic  branches  of  motor,  sensory,  vaso-motor 
and  secretory  nerves  to  the  viscera.  Irritation 
removed,  the  nerves  return  to  normal. 

Third.  Steady  pressure  on  the  posterior  divisions 
of  the  spinal  nerves  inhibits  sensory,  and  vaso-motor 
impulses  to  and  from  the  center,  thus  retarding  all 
forms  of  activity.  Rapid  alteration  of  pressure 
increases  activity  of  the  organ  thus  increasing 
impulses  to  it. 

Fourth.  Steady  pressure  may  restore  visceral  life 
by  removing  muscular  contracture  which  has  served 
as  an  inhibition. 


114 

THE  EXAMINATION  OF  THE  SPINE. 
That  we  may  intelligently  examine  a  spine  we 
should  be  thoroughly  acquainted  with  the  general 
topography  of  the  back.  I  shall  after  Holden  give 
you  a  brief  outline  of  the  landmarks  of  the  back.  It 
must  be  remembered  that  the  normal  spine  has  four 
curves,  as  follows:  (i)  The  cervical,  concave  back- 
ward, extending  from  the  apex  of  the  odontoid  to  the 
second  dorsal.  (2)  Beginning  at  the  middle  of  the 
second  dorsal  and  extending  to  the  twelfth,  its 
concavity  forward  is  the  dorsal  curve.  The  most 

The  spinal 

curves.  prominent  point  is  at  the  seventh  and  eighth  dorsal. 

(3)  The  lumbar  curve,  from  the  middle  of  the  twelfth 
dorsal  down  to  the  angle  between  the  fifth  lumbar  and 
the  base  of  the  sacrum,  its  concavity  being  directed 
backward.  (4)  From  the  base  of  the  sacrum  to  the  tip 
of  the  coccyx,  its  concavity  forward,  is  the  pelvic  curve. 
Care  must  be  taken  to  become  thoroughly  familiar 
with  the  normal  in  order  that  any  variation  from  this 
type  may  be  detected.  There  will  be  variations 
within  a  limited  range,  even  in  health.  The  dorsal 
and  pelvic  curves  are  primary  and  are  due  to  the  shape 
of  the  vertebrae,  while  the  cervical  and  lumbar  are 
secondary  and  compensatory  and  exist  only  after 
birth,  their  existence  being  due  to  modifications  in  the 
form  of  the  intervertebral  discs.  There  is  one  point 


115 

in  which  the  beginner  is  apt  to  be  deceived, 
particularly  in  the  female.  The  lumbar  curve 
beginning  at  the  sacro- vertebral  articulation,  drops 
forward  very  abruptly  and  if  this  should  be  further 
increased  in  appearance  by  well  developed  nates,  the 
operator  may  be  deceived.  The  test  must  be  made  by 
a  careful  examination  for  tenderness  on  pressure. 
The  spine  should  lie  in  a  perpendicular  plane  while 
the  patient  is  sitting  or  standing  erect,  though  there 
is  often  a  slight  lateral  curvature  in  the  dorsal  region, 
the  convexity  of  which  is  directed  toward  the  hand 
which  is  habitually  used.  This  is  doubtless  caused  by 
the  increased  strength  of  the  muscles  of  that  side  and 
also  the  compensatory  position  taken  by  the  head  and 
cervical  region.  Again  the  tips  of  the  vertebral 
spines  should  lie  in  a  perpendicular  plane,  which  may 
be  tested  by  bringing  the  hand  briskly  down  over  the 
spines  either  directly  over  it  or  with  two  fingers,  one 
on  each  side  of  the  prominences  of  the  spines.  By 
this  method  one  may  detect  any  deviation  from  the 
usual  position,  and  if  tenderness  be  present  this  may 
serve  as  an  evidence  of  a  lesion,  and  reasoning  from 
cause  to  effect,  the  organ  or  organs  affected  may  with 
certainty  be  determined.  But  care  must  be  used  in 
the  matter  of  finding  a  lesion.  The  atlas  has  no 
spine,  only  a  mere  tubercle  and  no  surprise  should  be 


116 

manifested  at  finding  it  "forward."  The  second 
cervical  is  perhaps  the  most  prominent  feature  in  the 
cervical  region  of  a  normal  spine  and  its  widely 
bifurcating  and  massive  spinous  process  may  give  the 
beginner  some  uneasiness.  The  cervical  spines  are 
bifid  from  the  second  to  the  sixth  inclusive.  The 
vertebra  prominens  is  close  to  the  first  dorsal,  the 
latter'very  commonly  being  mistaken  for  it. 

To  examine,  bare  the  spine,  have  the  patient  sit 
erect.  Note  the  curves  whether  they  be  normal, 
indications.  diminished  or  accentuated.  A  flat  region  in  the  upper 
dorsal  means  lung  and  heart  action  impaired,  and 
weakened  vitality.  If  the  fifth  to  tenth  dorsal  are 
anterior,  or  if  the  lumbar,  dorsal  and  cervical  are 
almost  in  line  there  will  be  stomach  and  intestinal 
disorders.  Any  marked  deviation  from  the  normal 
curve  in  the  lumbar  region  may  result  in  constipation, 
ovarian  or  uterine  disorder,  or  it  may  cause  derange- 
ment of  the  function  of  the  bladder.  The  sacral 
vertebra  are  relative  to  each  other  always  in  place  but 
they  may  be  slightly  out  of  their  true  articulation 
with  either  the  auricular  processes  of  the  ilium  or 
with  the  lumbar  vertebra  above  or  the  coccyx  below. 
In  lesions  of  the  lumbo-sacral  and  sacro-iliac  articula- 
tions you  will  find  pelvic  disturbances.  The  coccyx 
may  by  dislocation  cause  constipation,  haemorrhoids 


117 

and  piles.  Detect  any  lateral  curves  that  may  be 
present  by  careful  inspection.  Friction  will  bring  into 
view  the  spines  and  any  marked  separation  or 
deviation  from  the  perpendicular,  the  patient  sitting 
erect,  should  call  for  careful  palpation. 

lyocate  the  second  cervical  by  its  prominence.  The 
first  dorsal  by  the  length  of  its  spinous  process.  The 
third  dorsal  by  the  level  of  the  scapular  spine.  The 
seventh  dorsal  by  the  angle  of  the  scapula.  The  fourth 
lumbar  by  the  fact  that  a  line  from  the  iliac  crests  will 
pass  through  its  body. 

The  twelfth  dorsal  may  be  conveniently  located  by 
having  the  patient  fold  his  arms  and  lean  forward  thus 
throwing  into  prominence  the  trapezii,  whose  converg- 
ing external  borders  will  indicate  the  twelfth  spine  or 
better  by  the  articulation  with  the  last  rib  or  by  the 
natural  break  between  it  and  the  first  lumbar.  After 
being  satisfied  with  inspection,  a  careful  examination 
with  the  hand  will  detect  any  irregularity  that  the 
eye  may  overlook.  The  spines  are  the  key  to  the 
situation,  but  the  tenderness  in  addition  to  abnormal 
position  must  be  found. 

Each  operator  will  have  his  preference  for  position 

Positions  for 

of  the  patient.  For  a  thorough  examination  many 
positions  may  be  necessary.  The  following  order  is 
suggested,  the  back  being  exposed  in  all  cases  : 


118 

First.     Patient  sits  erect,  operator  standing  behind. 

Second.  Patient  leans  forward,  sitting  squarely, 
hands  on  knees. 

Third.  The  patient  is  placed  facing  operator,  first 
on  right  and  then  on  left  side.  The  operator  carefully 
examines  each  spine  and  transverse  process  in 
succession.  During  this  examination  the  patient 
must  thoroughly  relax.  The  operator  uses  arms  and 
legs  of  patient  as  levers  for  movement  in  examination. 

Fourth.  Patient  on  back,  body  straight  so  that 
nose,  chin  and  point  between  feet  are  in  straight  line, 
arms  at  sides.  The  operator  now  stands  at  head  and 
examines  both  sides  of  vertebrae  of  neck.  The  spines 
of  cervical  vertebras  cannot  be  relied  upon  for  diagnosis 
so  we  examine  transverse  processes.  Deviation  from 
a  straight  line  either  antero-posteriorly  or  laterally 
indicates  trouble  at  that  point.  An  examination  of  its 
spine  will  usually  confirm  this  result.  The  atlas  can 
be  examined  only  at  its  transverse  process  which 
should  be  easily  felt  about  half  way  between  mastoid 
process  and  the  decending  ramus  of  the  inferior 
maxilla.  Tenderness  is  usually,  if  not  always, 
most  pronounced  on  the  side  of  the  slip.  The  end  of 
the  little  finger  may  usually  be  passed  between  the 
transverse  process  and  the  ramus  of  the  jaw  if  in 
normal  position. 


CHAPTER  VII. 


REGIONS  OF  HEAD  AND  THORAX. 

THE  covering  of  the  upper  part  of  the  head  is 
called  the  scalp.  It  consists  of  skin  over  an 
aponeurosis  of  the  occipito-frontalis  muscle,  which  be- 
comes muscular  in  front  and  behind.  The  chief  bony 
prominences  are  the  occipital  protuberance  behind, 
the  mastoid  process  just  behind  and  on  a  level  with 
the  lobule  of  the  ear,  and  the  zygoma. 

The  arteries  of  the  scalp  are  the  supraorbital,  mak- 

Arteries  and 

ing  its  exit  at  the  supraorbital  ndtch;  the  temporal 
from  the  external  carotid  passing  up  in  front  of  the 
ear,  distributed  to  the  anterior  and  middle  part  of  the 
scalp ;  the  posterior  auricular  to  the  posterior  part  of 
the  scalp  passes  posterior  to  the  apex  of  the  mastoid 
process  the  occipital  from  the  external  carotid. 

The  nerves  supplying  sensory  fibres  to  the  scalp  are 
the  supratrochlear,  reached  at  the  inner  angle  of  the 
orbit,  the  supraorbital  reached  above  the  supraorbital 


120 

notch,  the  temporal  branch  of  the  tempo-malar  half- 
way between  the  eye  and  upper  margin  of  ear,  and  the 
auriculo-temporal  best  reached  in  front  of  tragus. 
These  are  all  branches  of  the  fifth  nerve.  In  addition 
the  small  occipital  and  great  occipital  innervate  the 
posterior  portion  of  the  scalp.  These  are  both  from 
the  second  cervical  and  may  be  reached  at  their  exit. 

These  nerves  are  frequently  affected  in  headaches. 
Pressure  at  the  points  named  will  relieve  this  con- 
dition. 

The  muscles  of  the  face,  excepting  those  of  mastica- 
tion, are  supplied  by  the  seventh  nerve.  This  nerve 
makes  it  exit  from  the  stylo-mastoid  foramen,  anterior 
to  the  mastoid  process,  and  may  be  reached  between 
the  mastoid  process  and  the  ramus  of  the  jaw. 

The  sensory  nerve  of  the  face  is  the  fifth,  supplying 
also  the  muscles  of  mastication.  This  nerve  is  affected 
in  neuralgia  and  is  treated  by  steady  pressure  at  the 
following  points :  At  the  supraorbital  notch  and  at 
the  infraorbital  and  mental  foramina.  A  line  passed 
from  the  supraorbital  notch  to  a  point  between  the  two 
bicuspid  teeth  will  pass  through  these  points.  Indi- 
rectly it  may  be  reached  through  its  sensory  distribu- 
tion from  Meckel's  ganglion,  lying  in  the  spheno- 
maxillary  fossa. 


121 

The  arteries  to  the  face  are,  the  facial  and  branches 
from  the  temporal.  The  facial  may  be  felt  as  it  crosses 
the  horizontal  ramus  of  the  lower  jaw. 

The  mouth  requires  much  attention  in  disease.  The 
points  which  the  osteopath  may  reach  within  this  are 
the  uvula,  in  the  middle  line  posteriorly,  the  posterior 
nerves  to  be  reached  and  pressed  upon  in  catarrh,  the 
tonsils  latterly  between  the  anterior  and  posterior  pil- 
lars of  the  fauces. 

The  pits  into  which  open  the  Kustachian  tubes  may 
be  reached  in  the  posterior  and  lateral  portion  of  the 
pharynx.  The  ninth  nerve  supplies  the  tonsils,  part 
of  pharynx,  Eustachian  tube  and  tympanum  with 
sensory  fibres.  Treatment  of  this  nerve  is  necessary 
in  catarrhal  deafness. 

The  neck  is  one  of  the  most  important  regions  of 

the  body  to  the  osteopath.     Its  drainage  is  accomp- 

The  neck. 

lished  largely  through  the  external  and  the  anterior 
jugular  veins,  the  former  in  line  from  the  angle  of  the 
jaw  to  the  middle  of  the  clavicle,  the  anterior  lying  in 
front  of  the  sterno-cleido-mastoid.  The  internal  carotid 
lies  in  the  carotid  sheath,  extending  from  the  mastoid 
process  to  the  inner  end  of  the  clavicle.  The  first  two 
mentioned  are  superficial  and  pulsate  in  case  of  tricus- 
pid  incompetency.  In  the  neck,  in  front,  lie  the 
trachea,  the  larynx,  the  hyoid  bone,  the  latter  felt  just 
on  a  level  with  the  inferior  maxilla. 


122 

Beneath  the  sterno-clavicular  joint  lie  the  innom- 
inate veins,  the  common  carotid  on  the  left  and  a  divis- 
ion of  the  innominate  on  the  right.  Rising  into  the 
neck  may  be  felt  the  subclavian  artery. 

The  important  muscles  in  the  front  of  the  neck  are 
the  sterno-hyoid  and  sterno- thyroid.  At  the  side  is 
the  sterno-cleido-mastoid,  while  deeper  lie  the  scaleni, 
the  rectus  capitus  anticus  major  and  minor,  and  the 
longus  colli.  Contracture  of  these  muscles  is  often  an 

Contractun 

interference  to  drainage  of  the  organs  in  the  head  and 
neck.  The  muscles  in  the  posterior  portion  of  the 
neck,  which  the  osteopath  is  called  upon  to  relax,  are 
trapezius,  levator  anguli  scapulae  and  the  rhomboids. 
More  deeply  lie  the  serratus  superior  and  splenius. 
Beneath  these  are  the  muscles  which  correspond  to  the 
erector  spinae  and  still  more  deeply  are  the  complexus, 
the  rectus  capitis  posticus  major  and  minor,  and  the 
obliquii.  Deep  in  the  neck  may  be  felt  the  transverse 
processes  and  their  corresponding  spines.  Superfici- 
ally in  the  middle  line  behind,  is  the  ligamentum 
nuchae.  This  may  be  stretched  by  holding  the  trunk 
and  pushing  the  head  and  neck  downward  and  for- 
ward. 

The  vertebral  artery  may  be  compressed  as  it  passes 
over  the  atlas  just  beneath  the  base  of  the  skull. 
This  is  a  point  useful  in  treating  headache. 


123 


For  examination  the  thorax  is  divided  into  four 
regions,  anterior,  posterior  and  two  lateral. 

The  anterior  is  surrounded  by  a  line  passing 
through  the  upper  ring  of  the  trachea,  horizontally  to 
the  sterno-cleido-mastoid,  thence  to  the  inner  end  of 
the  outer  fourth  of  the  clavicle.  From  this  point  it 
is  bounded  laterally  by  the  anterior  axillary  line, 
which,  extending  downward,  passes  through  the  point 


Anterior 


DIAGRAM   SHOWING  SUBDIVISIONS   OF  THE  ANTERIOR 
REGION   OF  THE  THORAX. 


(1)  Supra-Clavicular. 

(2)  Clavicular. 

(3)  Infra-Clavicular. 

(4)  Mammary. 

(5)  Infra-Mammary. 

(6)  Supra-Sternal. 


(7)  Superior  Sternal. 

( 8 )  Inferior  Sternal. 

( 9 )  Area  for  Pulmonary  sound. 

(10)  Area  for  Aortic  sound. 

(11)  Area  for  Tricuspid  sound. 


Mitral  sound  is  heard  at  point  of  cardiac  impulse  over  apex  of 
heart. 


124 

at  which  the  pectorales  muscles  leave  the  chest,  ending 
at  the  lower  margin  of  the  twelfth  rib.  Inferior ly  it 
is  bounded  by  the  inferior  margin  of  the  twelfth  ribs 
and  lower  end  of  the  sternum.  This  area  is  sub- 
divided into  a  middle  portion  by  the  sternum  and  that 
region  lying  within  the  sterno-cleido-mastoid  muscles 
above  the  sternum  inferior  to  the  line  forming  the 
superior  boundary  of  the  anterior  area. 

That  portion  of  the  middle  region  lying  above  the 
sternum  is  called  the  suprasternal  region.  It  contains 
the  upper  part  of  the  oesophagus  and  the  trachea. 
Within  this  area  also  lies  the  vagi  nerves,  the  common 
carotid  arteries  and  the  jugular  veins,  three  very 
important  structures.  The  phrenic  nerves  may  be 
reached  in  this  region  as  they  pass  into  the  thorax 
beneath  the  sterno-cleido-mastoid  muscles.  The 
steruo-hyoid  and  sterno-thyroid  muscles  are  within  this 
space  and  lie  anterior  to  a  most  important  structure, — 
the  thyroid  gland.  This  body  lies  on  either  side  of 
the  trachea  and  is  connected  by  a  bridge  of  glandular 
structure  covering  the  second,  third  and  fourth 
tracheal  rings.  The  lateral  lobes  of  the  gland  lie 
upon  the  inferior  constrictor  of  the  pharynx  superiorly, 
and  lower  lies  upon  and  external  to  the  trachea. 
Posterior  to  it  lie  the  carotid  sheath  and  the  inferior 
thyroid  artery  and  the  recurrent  laryngeal  nerve. 


125 

The  lower  portion  of  the  gland  lies  beneath  the  omo- 
hyoid,  the  steruo-hyoid  and  the  sterno-thyroid 
muscles.  This  gland  is  of  interest  to  the  osteopath  in 

Thyroid  gland. 

goiter.  The  muscles  above  mentioned  are  contracted 
in  case  of  enlargement  of  the  gland.  The  veins 
draining  this  structure  are  the  superior  and  middle 
thyroid  veins  emptying  into  the  internal  jugular,  and 
the  inferior  thyroid  emptying  into  the  innominate. 
The  arteries  supplying  it  are  the  superior  thyroid  from 
the  external  carotid,  the  inferior  thyroid  from  the 
thyroid  axis  of  the  subclavian  artery  and  occasionally 
a  branch  from  the  innominate  or  the  aorta,  the  media 
or  thyroidea  ima.  Its  nerves  are  from  the  middle  and 
inferior  ganglia  of  the  cervical  sympathetic.  On 
account  of  the  exceedingly  rich  vascular  supply  to 
this  organ  and  its  peculiar  relation  to  vaso-motor 
disturbances,  treatment  should  be  toward  regulating 
the  vaso-motor  through  the  cervical  region.  There 
may  be  physical  obstruction  to  the  drainage  through 
the  muscular  contractures.  Or  there  may  be  com- 
pression of  the  subclavian  artery  owing  to  a  depressed 
clavicle,  or  an  elevated  first  rib.  Careful  examination 
should  always  be  made  of  the  head  of  the  first  rib  in 
such  a  case,  as  tenderness  there  may  indicate  it  is 
turned. 


126 

To  the  structures  lying  within  this  region  let  us  add 
the  apex  of  the  lung  extending  an  inch  above  the 
clavicle,  lying  deep  behind  the  sterno-mastoid  and 
sterno- thyroid  muscles.  This  portion  of  the  lung  is 
peculiarly  liable  to  tubercular  infection  and  should  be 
carefully  examined.  The  laryngeal  nerves  are  also 
reached  in  this  region. 

The  superior  sternal  region  is  of  comparatively 
little  importance  from  the  osteopathic  standpoint,  save 
in  diagnosis.  It  is  separated  from  the  inferior  sternal 
region  by  a  line  drawn  on  a  level  with  the  upper 
margin  of  the  third  rib. 

The  inferior  sternal  region  corresponds  to  that  por- 
tion of  the  sternum  lying  below  the  line  above  men- 
tioned. Covered  as  are  these  regions,  they  are  diffi- 
cult to  reach,  and  it  is  through  spinal  treatment  that 
the  osteopath  secures  his  results.  In  the  superior 
sternal  region  the  vena  cava  descendens,  the  pulmon- 
ary artery  and  the  bifurcation  of  the  trachea  are  found, 
while  the  lung  tissue  encroaches  upon  this  area  below 
the  level  of  the  second  costal  cartilage. 

In  the  inferior  sternal  region  are  found  a  portion  of 
the  right  auricle,  the  beginning  of  the  aorta,  and  the 
pulmonary  artery.  The  right  ventricle  lies  largely 
within  this  space,  while  both  lungs,  the  left  and  the 
right,  and  the  liver  contribute  to  filling  it.  There 


127 

may  be  malformations  of  the  sternum  as  a  result  of 
dress,  occupation,  or  a  rachitic  condition  in  early  child- 
hood. Very  little  can  be  done  to  overcome  this  condi- 
tion, though  by  pressure  on  the  sternum  and  traction 
on  the  lateral  thoracic  walls  by  means  of  the  pectoral 
muscles,  the  lateral  diameter  of  the  chest  may  be 
incrsased.  This  treatment  may  be  very  effective  if 
administered  in  the  early  stages  of  the  disease. 

In  the  supraclavicular  region  is  an  important  struc- 
ture, the  subclavian  artery.  Its  pulsations  can  be  seen 
and  felt  near  the  outer  border  of  the  sterno-mastoid 
muscle,  about  an  inch  above  the  clavicle.  We  may 
desire  to  compress  the  artery  in  this  position  just  as  it 
crosses  over  the  first  rib.  It  is  here  that  we  may 
reach  the  annulus  of  Vieussens  and  the  trunks  of  the 
brachial  plexus.  To  treat  this  region,  it  is  usually 
most  convenient  to  stand  behind  the  patient;  while 
the  patient  sits,  with  the  head  slightly  inclined  toward 
the  side  treated.  The  arm  is  used  as  a  lever  to  throw 
the  structures  in  different  relations  to  each  other,  thus 
insuring  the  effect  of  the  manipulations.  In  this 
region  the  relation  of  the  first  rib  to  the  clavicle  may 
be  detected.  Normally  the  end  of  the  finger  or 
thumb  may  be  pushed  between  the  two.  In  case  the 
clavicle  is  depressed  it  can  be  raised  by  passing  the 
thumb  beneath  the  clavicle  near  its  middle  portion  and 


128 

using  the  arm  as  a  lever  throwing  it  upward,  outwards 
and  forwards  there  will  be  felt  pressure  on  the  thumb, 
thus  elevating  the  sternal  portion.  The  operator  must 
remember  that  the  shoulder  is  easily  dislocated  and 
must  use  due  care  that  no  injury  is  done.  A  depressed 
clavicle  may  obstruct  the  subclavian  vein. 
infraciavicu-  The  structures  lying  beneath  the  clavicles  and  the 

Zar  region. 

upper  portion  of  the  sternum  are  of  great  importance 
to  the  osteopath,  including  the  vessels  of  which  we 
have  spoken,  the  internal  mammary  artery  and  the 
phrenic  and  pneumogastric  nerves. 

The  infraclavicular  regions  extend  from  the  lower 
margin  of  the  clavicles  to  the  inferior  border  of  the 
third  rib  and  are  almost  wholly  filled  with  lung  tissue. 
It  is  here  that  phthisis  usually  manifests  itself,  so  that 
the  study  of  this  region  is  important.  There  is  a 
marked  difference  in  the  position  of  the  two  bronchi: 
the  right,  larger  and  more  horizontal  than  the  left, 
enters  the  lung  at  the  level  of  the  second  costal  carti- 
lage at  its  upper  border  ;  the  left  passing  beneath  the 
aortic  arch,  reaches  the  lung  an  inch  lower,  beneath 
the  third  costal  cartilage.  This  makes  some  slight 
difference  in  the  tympanitic  note  of  these  regions.  At 
the  point  of  union  of  the  second  rib  and  cartilage  the 
aortic  sound  is  best  heard  on  the  right  side,  while  in 
the  corresponding  position  on  the  left  side  the  pulmon- 


129 

ary  sound  is  heard.  The  right  infraclavicular  region 
contains  lung  tissue,  the  vena  cava  descendens  and  the 
right  bronchus.  The  left  side  contains  lung  tissue, 
the  left  bronchus  and  the  pulmonary  artery,  the  base 
of  the  heart  and  a  part  of  the  ascending,  transverse 
and  descending  portions  of  the  arch  of  the  aorta. 
This  region  often  manifests  tenderness  on  pressure  in 
case  of  diseased  condition  of  the  lung  and  should  be 
carefully  examined.  The  costo-chondral  articulations 
very  frequently  in  such  cases  show  most  marked 
tenderness. 

At  the  outer  extremity  of  this  region,  extending  Co8to.coraeoM 

.  ,  ,  membrane. 

downward  from  the  coracoid  process  to  the  upper  mar- 
gin of  the  pectoralis  minor  muscle  is  the  costo-coracoid 
membrane.  It  lies  over  the  subclavian  vessels  and  is 
pierced  by  the  cephalic  vein,  acromial  thoracic  artery 
and  vein,  the  superior  thoracic  artery  and  the  anterior 
thoracic  nerves  to  the  pectorales  muscles.  Its  impor- 
tance cannot  be  overestimated  in  cases  of  rheumatic 
conditions  of  pectoral  and  deltoid  muscles,  also  in 
drainage  to  arm  and  shoulder.  The  mammary  region, 
extending  from  the  infraclavicular  to  the  inferior  mar- 
gin of  the  sixth  rib,  contains  lung  tissue,  while  the 
heart  lies  within  the  mammary  and  inferior  sternal  and 
infraclavicular  regions.  Its  base  lies  almost  exactly  on 
the  level  of  the  third  rib.  The  apex  lies  at  a  point 


130 

midway  between  the  mammary  and  parasternal  lines  in 
the  fifth  interspace,  an  inch  and  a  half  below  and  an 
inch  median  to  the  nipple.  It  extends  three-quarters 
of  an  inch  to  the  right  of  the  sternum.  The  area  of 
superficial  cardiac  dullness  is  confined  to  the  left  mam- 
mary region.  The  right  side  contains  in  the  mammary 
region  the  lung,  the  right  auricle  and  ventricle  ;  the 
left  side,  the  left  lung  and  the  heart. 

The  infra-mammary  region,  lying  below  the  inferior 
margin  of  the  sixth  rib,  contains  the  corresponding 
lung,  on  deep  inspection,  and  the  corresponding  lobe 
of  the  liver.  The  right  infra-mammary  affords  the 
point  beneath  its  inner  boundary  for  directly  stimulat- 
ing the  liver,  one  of  the  most  potent  methods  of  over- 
coming torpidity  of  the  liver  and  curing  constipation. 
To  treat  the  liver  at  this  point  the  patient  should  be 
either  on  his  back  or  on  his  left  side,  the  knees  and 
thighs  both  gently  flexed  to  loosen  the  wall  of  the 
abdominal  region  ;  then  with  the  hand  placed  just 
internal  to  the  line  of  the  cartilages  the  patient  is  told 
to  take  a  deep  breath  and  then  exhale.  Synchronous 
with  the  exhalation  the  operator  presses  forcibly 
upward  and  outward.  Under  the  dependent  portion  of 
the  liver,  at  a  point  just  below  the  middle  of  the  inner 
border  of  this  region,  lies  the  bile  cyst,  its  fundus 
sometimes  extending  below  the  margin  of  the  liver, 


131 

under  which  circumstances  it  may  be  easily  felt. 
Pressure  and  stimulation  here  tends  to  empty  the  cyst 
by  increasing  the  peristalsis  of  the  cyst,  rather  than 
by  forcible  ejection.  The  fundus  of  the  stomach  lies 
chiefly  within  the  left  infra-mammary  region  and 
extends  well  up  into  the  mammary  area,  while  the 
pyloric  end  stretches  across  and  ends  under  the  right, 
thus  placing  a  part  of  the  duodenum  and  the  hepatic 
flexure  of  the  colon  beneath  this  area,  the  splenic  flex- 
ure of  the  colon  entering  the  left. 

The  lateral  areas,  the  right  and  left,  extend  from 
the  anterior  axillary  line  in  front  to  the  anterior  mar-  Lateral  areas. 
gin  of  the  axillary  scapula  posteriorly.  Above  it  is 
bounded  by  the  axilla  and  below  by  the  margin  of 
the  false  ribs.  A  line  drawn  from  the  level  of  th« 
superior  border  of  the  sixth  rib  to  the  inferior  angle  of 
the  scapula  divides  this  region  into  an  axillary  region 
above  and  the  infraaxillary  below.  Within  this 
region,  behind  the  pectoralis  muscles,  may  be  felt  the 
pulsations  of  the  axillary  artery,  which  here  gives  off 
branches  supplying  the  structures  forming  the  lateral 
wall,  while  the  brachial  plexus  of  nerves  may  be  very 
markedly  affected  in  this  region.  The  drainage  of  the 
arm  may  be  influenced  by  treating  here  the  lym- 
phatics of  the  axilla  and  the  axillary  vein.  The 
branches  of  the  intercostal  nerves  in  this  region  are 


132 

particularly  sensitive  in  case  of  any  abnormality  in 
the  position  of  the  ribs,  and  on  the  left  side  they  will 
reflect  any  disturbance  in  function  or  structure  of  the 
heart ;  on  either  side,  lungs  and  bronchi.  The  main 
bronchi  are  placed  deeply  within  this  area. 

The  infraaxillary  regions  contain  beneath  their 
surfaces  lung  tissue.  In  addition,  the  right  one  con- 
tains the  right  lobe  of  the  liver.  The  left  also  con- 
tains the  spleen  and  the  fundus  of  the  stomach. 

The  posterior  region  of  the  chest  extends  from  the 
first  dorsal  spine  along  the  boundary  of  the  supra- 
spinous  fossae  to  acromion  process,  thence  along  the 
axillary  margin  of  the  scapula  to  the  inferior  angle, 
thence  perpendicularly  downward  to  the  lower  border 
of  the  twelfth  rib,  thence  along  the  border  of  that  rib 
to  the  twelfth  spine.  The  same  direction  on  the  other 
side  gives  the  completed  boundary.  A  horizontal  line 
through  the  inferior  angle  of  the  scapula  divides  it  into 
a  subscapular  region  below,  further  subdivided  into  a 
right  and  left,  while  the  superior  portion  is  again  sub- 
divided into  a  suprascapular  region,  lying  above  the 
scapular  spine  on  either  side  corresponding  to  the 
suprascapular  fossae,  a  scapular  region  corresponding  to 
the  infraspinous  fossae,  and  a  region  lying  between 
these,  the  interspinous  region.  The  suprascapular 
regions  cover  the  apices  of  the  lungs,  and  contain 


133 


DIAGRAM   SHOWING  DORSAL  THORACIC   REGION   AND 
ITS  SUBDIVISIONS. 


(1)  Supra-Scapular. 

(2)  Scapular. 


(3)  Sub-Scapular. 

(4)  Inter  Scapular. 


supraspinati  muscles  covered  by  trapezii.  The  supra- 
scapular  nerve  passes  in  through  the  suprascapular 
notch  and,  passing  downward  under  the  acromion  pro- 
cess, is  distributed  to  the  infraspinatus  muscle.  We 
here  treat  the  deltoid  muscle  through  its  nerve,  the 
circumflex,  which  is  distributed  to  the  skin  over  the 
shoulder  joint,  and  to  the  teres  minor  and  the  deltoid. 
This  nerve,  a  branch  from  the  posterior  cord  of  the 
brachial  plexus,  has  its  origin  in  fibres  coming  from 


134 

the  fifth,  sixth,  seventh  and  eighth  cervical,  inclusive. 
Lying  beneath  this  region  is  the  substance  of  the  lung. 

The  scapular  area  reaches  to  the  eighth  rib  and 
corresponds  to  the  infraspinous  fossa,  though  it 
extends  more  lateral  than  it.  It  is  filled  in  by  the  tra- 
pezius  and  infraspinatus  muscles,  while  the  lower  and 
lateral  portion  is  crossed  by  the  latissimus  dorsi  and 
teres  major  muscles.  The  relation  of  the  latissimus 
dorsi  to  the  scapula  is  an  important  one,  serving  to 
bind  the  scapula  down  at  its  inferior  angle.  Beneath 
the  scapula  lies  the  subscapularis  muscle.  It  is  worthy 
of  note  that  the  latissimus  dorsi,  the  teres  major  and 
the  subscapularis  having  related  functions  are  supplied 
by  the  subscapular  nerves,  which,  like  the  circumflex, 
take  origin  from  the  cervical  nerves,  the  fifth,  sixth, 
seventh  and  eighth.  The  deep  contents  of  the  scapu- 
lar region  are  lung  tissue.  Its  chief  importance  to 
the  osteopath  consists  in  its  relation  to  the  shoulder, 
and  the  further  fact  that  the  scapula  offers  a  leverage 
on  his  patient. 

The  infrascapular  regions  contain  lung  and  kidney 
on  either  side  and  on  the  right  a  large  portion  of  the 
right  lobe  of  the  liver ;  on  the  left  side,  part  of  the 
spleen  and  the  splenic  flexure  of  the  colon. 

The  right  subscapular  area  should  be  examined 
most  carefully,  as  in  this  region  tenderness,  either 


135 

superficial  or  intercostal,  may  manifest  itself.  This  is 
the  liver  region,  and  tenderness  over  it  or  deeply 
beneath  it  means  some  disturbance  in  liver  structure 
or  function.  At  the  spine  are  the  centers  for  the  liver, 
the  kidney,  the  spleen  and  the  small  intestine.  In 
fact,  of  so  great  importance  is  the  spinal  region  of  the 
cervix,  thorax,  abdomen  and  pelvis,  bounded  laterally 
by  lines  drawn  through  the  tips  of  the  transverse  pro- 
cesses of  the  vertebra  in  the  cervical  region,  the 
angles  of  the  ribs  in  the  dorsal,  the  transverse  pro- 
cesses in  the  lumbar  and  the  lateral  margins  of  the 
sacrum  and  coccyx  in  the  pelvic  region,  that  this 
should  be  designated  the  spinal  region. 

In  the  interscapular  region  on  either  side  lie  the 
lung,  bronchial  glands,  the  main  bronchus  ;  while  the 
left  side  contains  in  addition  the  aorta,  oesophagus  and 
thoracic  duct.  Within  this  interscapular  region  are 
the  following  centers :  The  lungs  and  bronchial 
tubes,  the  stomach,  the  liver,  the  upper  part  of  the 
small  intestine,  and  the  augmentor  fibres  to  the  heart. 
The  muscles  of  the  space  are  the  trapezius,  covering 
the  whole  area,  the  latissimus  dorsi  which  covers  the 
lower  portion.  Connecting  the  scapula  with  the  spine 
are  the  rhomboidei  major  and  minor  and  the  levator 
anguli  scapulse  and  more  deeply  lying  are  the  splenius 
capitis  et  colli  and  erector  spinse.  In  case  of  trouble 


136 

in  any  organ  supplied  by  nerves  from  this  region  of  the 
cord  there  will  be  tenderness  on  pressure  applied  to 
these  muscles.  This  is  the  logical  result  of  a  con- 
tracture  of  muscles,  and  before  the  normal  and  natural 
impulses  can  pass  along  the  efferent  and  afferent  fibres 
all  such  contractures  must  be  eliminated.  Thus  we 
work  upon  the  muscles  indicated.  To  do  this  most 
advantageously  use  the  arm  as  a  lever  and  by  pressure 
on  the  muscles  overcome  their  contraction.  It  is 
through  muscles  largely  that  we  secure  our  ends,  and 
by  removing  the  inhibition  or  the  irritation  which  re- 
sults from  their  pressure  upon  the  nerves  the  normal 
conditions  are  restored. 
Examination  To  examine  the  chest  the  patient  should  be  stripped 

of  chest. 

of  clothing  to  the  waist,  except  such  as  may  be  opened 
in  front  and  raised  behind,  a  loose  waist  or  dressing 
sack.  Avoid  draughts  and  cold.  The  patient  should 
stand  or  sit  with  body  erect  and  arms  hanging  evenly 
at  the  side.  Careful  inspection,  which  is  the  first 
method  of  examination  following  the  verbal,  will  re- 
veal the  general  shape  and  symmetry  of  the  chest, 
color,  nutrition,  size,  the  presence  of  tumors  and 
abdominal  bulging,  or  flattening  of  the  chest  wall. 

The  front  of  the  chest  should  be  first  examined  ;  for 
this  purpose  Ftand  in  front  of  the  patient.  Perfect 
symmetry  is  rare.  Unusual  development  of  the 


137 

muscles,  unusual  development  of  a  viscus,  occu- 
pation or  spinal  curvature  are  frequent  causes 
of  asymmetry.  But  marked  malformations  are  not 
necessarily  incompatible  with  healthy  lungs  and 
heart.  The  apex  beat  of  the  heart  may  or  may  not 
be  seen.  The  undulatory  movements  of  the  chest 
should  be  the  same  on  both  sides,  any  marked  varia- 
tions either  in  rhythm  or  depth  from  the  normal  would 
suggest  disease.  Inspection  should  not  reveal  any 
difference  between  the  right  and  the  left  sides.  There 
maybe  coloring  of  the  skin,  either  natural  or  acquired; 
if  the  latter  it  may  be  pigmentation,  as  in  diseases  of 
the  sympathetic  nervous  system,  or  in  hepatic  disturb- 
ances. There  may  be  unusual  color  due  to  vasculari- 
zation,  either  a  natural  erythema,  ruddy  complexion, 
or  the  opposite.  On  the  other  hand  there  may  be  evi- 
dences of  congestion,  with  eruptions  as  the  result  of 
arterial  distension.  From  venous  stasis  may  come 
ecchymosis  and  enlarged  capillaries  and  superficial 
veins.  Aside  from  this  there  may  be  either  cyanosis, 
anaemia,  pallor  or  general  congestion. 

Detect  any  local  bulging  due  to  tumors  or  abscesses 
within  the  chest  wall  or  to  deformities  of  the  bony 
structure.  There  may  be  asymmetry  due  to  pressure 
from  within,  as  hypertrophy  of  the  heart,  or  the  accu- 
mulation of  gases  or  fluids  within  the  pericardium,  or 


Enlargement. 


Osteopothic 
palpation. 


138 

hydro-  or  pneumo-pericardium.  The  lungs  may  exert 
a  pressure  on  the  chest  wall  in  tumors  and  swellings, 
and  in  pleuritic  accumulations  of  gas  or  fluids.  Even 
the  thoracic  form  may  be  modified  by  the  enlargement 
of  abdominal  organs  due  to  fibroid  growth,  or  to  the 
accumulation  of  gases  or  fluids. 

In  the  pigeon  breast  from  rachitis  there  is  marked 
projection  of  the  lower  end  of  the  sternum  and  a 
straightening  of  the  ribs  with  a  lessening  of  the  trans- 
verse diameter. 

The  alar  or  flat  chest  is  accompanied  by  a  narrow 
chest,  acute  costal  angle,  a  flattening  in  the  region  of 
the  dorsal  spinal  curve,  winglike  projecting  scapulae, 
drooping  shoulders,  and  neck  set  forward.  These  con- 
ditions are  accompanied  by  weakness  of  constitution, 
and  indicate  imperfect  expansion  of  the  lungs,  poor 
heart  action  and  inability  to  resist  disease.  Such  a 
patient  is  particularly  liable  to  pulmonary  tuberculosis. 

The  lateral  areas  should  be  examined  for  tumors, 
pleuritic  bulgings,  etc.  The  posterior  region  should 
be  carefully  inspected  for  abnormalities,  curvatures, 
straightening  of  spine,  contractures  of  muscles,  dis- 
placements, etc. 

The  osteopath  uses  inspection  just  as  the  medical 
practitioner,  and  reasons  from  cause  to  effect  through 
anatomical  connections.  When  the  osteopath  palpates 


139 

he  uses  the  name  and  changes  the  deed  both  in  method 
and  motive.  Palpation  to  the  old  school  meant  the 
'laying  on  of  hands  and  trying  to  gain  a  knowledge  of 
the  internal  condition  by  the  sonant  vibrations  from 
the  vocal  chambers  and  from  the  transmitted  move- 
ment of  the  apex  of  the  heart.  The  osteopath  uses  his 
finger  tips.  With  these  he  carefully  explores  the 
region  of  the  spine  determining  if  the  spinous  pro- 
cesses are  prominent  or  retreating.  He  determines 
any  deviation  from  the  perpendicular  line.  His  fingers 
tell  him  if  the  spines  be  separated,  representing  a  point 
of  weakness  or  a  break.  His  trained  fingers  carefully 
examine  the  articulation  of  the  tubercle  of  the  rib 
with  the  transverse  process  and  note  any  congestion, 
slip  or  thickening  of  the  tissue  here. 

Tenderness  in  any  of  these  locations  is  the  sign  of  a 
lesion,  of  the  organs  governed  by  that  centre.  This 
requires  a  careful  differential  diagnosis.  Should  there 
be  a  distinct  anatomical  disarrangement  thea  a  correc- 
tion of  this  condition  will  almost  certainly  remove  the 
disturbance.  Should  it  be  a  transferred  or  sympa- 
thetic tenderness,  then  the  effect  of  treatment  here 
may  be  transient  or  permanent.  Even  in  acute  cases, 
expect  osseous  lesion,  there  is  always  tenderness. 

To  examine  the  heart  there  must  be  first  an  ability  Sounds  of  me 

heart. 
to   distinguish   the  normal  sounds  and  the  locations 


140 

at  which  they  are  best  heard.  This  can  be  deter- 
mined by  means  of  the  ear  unaided,  but  the  stetho- 
scope or  phonendoscope  will  aid  in  localizing  and  in 
analyzing  the  sound.  The  points  at  which  you  would 
apply  the  ear  are  as  follows  : 

For  the  aortic  sound  at  the  union  of  the  second  rib 
and  its  cartilage  on  the  right  side.  For  the  pulmonary 
sound  the  corresponding  position  on  the  left  side. 
The  mitral  is  most  advantageously  heard  at  the  point 
of  the  cardiac  impulse  in  the  fifth  interspace.  This 
sound  is  also  heard  in  abnormal  conditions  between 
the  vertebral  margin  of  the  scapula  and  the  spine  at 
the  level  of  the  fifth  or  sixth  rib.  This  has  the 
advantage  of  being  entirely  removed  from  the  other 
heart  sounds.  It  is  important  to  remember  that  the 
mitral  valve  is  affected  more  frequently  than  any  other 
valve  of  the  heart.  Investigation  of  the  tricuspid  is 
best  conducted  at  a  point  just  below  the  end  of  the 
sternum  in  the  soft  wall,  or  else  at  the  cartilages  of 
the  false  ribs  on  the  right  side. 

The  theory  upon  which  the  osteopath  works  in 
treatment  of  cardiac  troubles  is  this  : 

Theory  of  First.      He   affects   the  amount  of  work  that  the 

cardiac 

treatment.         heart    is    doing   through  vaso-motors,    increasing  or 

decreasing  it  at  will  through  peripheral  resistance. 


141 

Second.  Through  augmentor  fibres  he  increases  or 
decreases  the  intensity  of  the  impulses  and  thus 
directly  affects  the  heart. 

Third.  Through  the  inhibitory  effect  of  the  vagus 
he  quiets  an  excited  heart. 

.Fourth.  Through  the  general  systemic  effect  of  the 
vaso-motors  and  the  cardiac  augmentors  he  contributes 
to  the  general  nutrition  of  the  heart. 

Fifth.  The  motor  nerves  to  the  papillary  muscles 
are  from  the  upper  dorsal,  and  by  these  any  valvular 
weakness  of  an  atonic  nature  may  be  removed. 

Sixth.  The  sensory  fibres  to  the  heart  are  from  the 
upper  dorsal  region.  Removal  of  any  irritation  to 
these  will  quiet  any  excited  condition  of  the  heart. 

Treatment  is  directed  to  all  these  sources.  Tender- 
ness is  usually  marked  at  the  angle  of  the  fifth  rib  on 
the  left  side,  also  at  the  chondral  articulation  of  this 
rib.  Pressure  at  these  two  points  at  the  same  instant 
will  produce  a  sensation  as  of  some  sharp  instrument 
passing  through  the  thorax.  Examination  of  the  ribs 
will  show  them  to  be  rotated  downward,  bringing  the 
inferior  margin  almost  in  contact  with  the  superior 
margin  of  the  rib  next  below.  This  results  in 
tenderness  of  the  intercostal  nerves.  The  treatment 
which  the  osteopath  administers  depends  upon  the 
nature  of  the  case.  Any  contracture  of  the 


142 

rhomboids,  or  the  more  deeply  lying  splenius, 
semispinalis,  multifidus  spinae,  transversalis  colli,  etc., 
must  be  removed,  and  in  case  of  nervous  affection  this 
treatment,  together  with  building  up  the  nutrition  of 
the  body  through  the  digestive  organs,  will  prove 
sufficient.  By  elevating  the  ribs  the-  capacity  of  the 
chest  is  increased,  thus  removing  the  pressure  upon 
the  pericardium.  This  frequently  is  done  in  cases 
in  which  the  patient  complains  of  a  feeling  of  smother- 
ing and  compression  of  the  heart. 

Relaxing  the  muscles  of  the  neck  and  pressure  upon 
the  middle  and  inferior  cervical  ganglia  will  reduce 
the  rapidity  of  the  heart-beat. 

Steady  pressure  on  the  solar  plexus  will  quiet  an 
over-exciting  heart. 

In  chronic  heart  trouble  you  will  find  costal  or 
vertebral  lesions.  Examine  carefully  the  vertebra 
from  the  second  to  the  fifth  dorsal.  To  treat,  relax  by 
pressure  the  interscapular  region,  place  patient  on 
right  side  and  pull  upward  and  forward,  pressing 
with  right  hand  against  angle  of  ribs.  Another 
movement  is  to  place  patient  on  face  and  put  sudden 
pressure  on  ribs  at  tubercle  or  transverse  process. 
Have  patient,  sitting,  lock  his  hands  behind  occiput. 
Standing  at  his  back  the  operator  passes  his  hands 
under  patients  arms  and  clasps  them  across  back  of 


143 

neck.      Pulling   downward  on   each   side   alternately 
will  aid  in  overcoming  an  anterior  condition. 

EXAMINATION  OF  THE  LUNGS. 

To  understand  the  location  of  the  lungs  it  is 
necessary  to  be  thoroughly  conversant  with  the 
landmarks  of  the  chest  and  with  the  location  of 
certain  lines.  A  perceptible  ridge  at  the  junction  of 
the  manubrium  with  the  gladiolus,  marks  the  level  of 
the  second  cartilage.  The  nipple  is  between  the 
fourth  and  fifth  ribs  just  external  to  their  cartilages. 

Thoracic 

The  lower  border  of  the  pectoralis  major  corresponds  hne*f 
with  the  fifth  rib.      The  scapula  covers  the  ribs  from 
the  second  to  the  seventh.     The  end  of  the  sternum  is 
at  the  level  of  the  tenth  dorsal  vertebra.      The  follow- 
ing lines  are  useful : 

The  mesosternal,  the  middle  line  of  the  chest 
anteriorly. 

The  sternal,  following  the  margin  of  the  sternum. 

The  niammillary,  parallel  to  the  mesosternal, 
through  the  nipple. 

The  parasternal,  midway  between  the  mammillary 
and  sternal. 

The  anterior  axillary,  a  perpendicular  line  dropped 
from  a  point  at  which  the  pectoralis  major  leaves  the 
thorax,  the  arm  extended. 


144 

The  posterior  axillary,  a  vertical  line  at  the  point 
where  the  latissimus  dorsi  leaves  the  chest,  arm 
extended. 

The  midaxillary  line,  midway  between  the  anterior 
and  the  posterior  axillary. 

The  scapular  line,  vertical  fronr  the  inferior  angle  of 
the  scapula. 

The  right  lung  extends  about  one  and  one-half 
inches  above  the  first  rib  into  the  suprascapular  region . 
It  follows  downward,  reaching  the  mesosternal  line  at 
the  second  costal  cartilage,  following  it  to  the  sixth, 
thence  it  turns  outward  following  the  sixth  rib  to  the 
mammillary  line.  It  is  at  the  eighth  rib  in  the  mid- 
axillary  line  and  at  the  tenth  rib  in  the  scapular  line. 
This  lung  has  three  lobes  formed  by  the  two  fissures, 
long  and  short.  The  long  fissure  extends  from  above 
and  behind  obliquely  downward  and  forward.  It 
begins  near  the  third  dorsal  vertebra  and  passes  to  the 
midaxillary  line  at  the  fourth  rib  and  cuts  the  mam- 
millary line  at  the  sixth.  The  short  fissure  begins 
near  the  anterior  border  of  the  scapula  at  the  level  of 
the  third  rib  where  it  unites  with  the  long,  passes 
downward,  inward  and  forward  to  the  junction  of  the 
fourth  costal  cartilage  with  the  sternum.  Above  this 
lies  the  upper  lobe  of  the  lung. 


145 

Between  the  third  and  the  lower  margin  of  the  sixth 
rib  is  the  middle  lobe.  The  lower  lobe  is  posterior  to 
and  below  the  long  fissure.  It  reaches  the  thoracic 
wall  in  the  lateral  and  subscapular  region,  but  is 
absent  in  front. 

The  left  lung  extends  one  inch  higher  into  the  neck   , 

Left  lung. 

than  the  right.  It  leaves  the  mesosternal  line  at  the 
fourth  costal  cartilage,  passes  obliquely  downward  to 
the  sixth  rib  in  the  mammillary  line  and  between  the 
eighth  and  ninth  ribs  at  the  midaxillary,  and  between 
the  tenth  and  eleventh  ribs  in  the  scapular  line.  It 
has  but  one  fissure  which  divides  it  into  the  upper  and 
lower  lobes. 

This  fissure  begins  near  the  third  vertebra,  extends 
downward,  forward  and  outward  to  the  midaxillary 
line  where  it  is  at  the  level  of  the  fourth  rib.  In  the 
mammillary  line  it  cuts  the  lower  margin  of  the  lung 
at  the  sixth  rib.  The  upper  lobe  anteriorly  occupies 
all  above  the  sixth  rib  ;  laterally,  above  the  fourth  rib, 
and  posteriorly  above  the  spine  of  the  scapula.  The 
lower  lobe  is  absent  anteriorly  and  lies  below  the  upper 
lobe,  posteriorly  and  laterally. 

In  examination  and  treatment  of  the  lungs  it  is  nec- 
essary to  keep  their  outlines  in  mind.  Their  space  is 
easily  encroached  upon  by  any  abnormality  in  the 
shape  of  the  thoracic  wall. 


146 

The  pleura  and  lungs  are  supplied  with  sensory 
fibres  from  the  spinal  nerves  coming  from  the  first  to 
the  seventh,  though  Quain  limits  it  to  the  upper  five. 
The  lungs  are  supplied  by  viscero-motor  fibres  from 
the  vagus  and  by  vaso-motor  fibres  from  the  upper 
dorsal,  though  some  observers  find  these  also  to  come 
from  the  vagus.  But  in  either  case  they  make  their 
exit  from  the  upper  dorsal  nerves. 
Treatment  of  Our  treatment  for  pulmonary  or  bronchial  trouble  is 

lungs. 

as  follows  :  Contractures,  in  the  upper  spinal  regions, 
are  reduced,  the  ribs  are  elevated  by  pressing  against 
their  tubercles  and  pulling  the  arm  upward  and  back- 
ward. The  patient  lying  on  his  back  the  hands  are 
drawn  up  over  the  head,  the  patient  inhaling  deeply, 
then  are  pushed  downward  as  he  exhales.  Another 
treatment  is  to  place  the  patient  on  a  stool ;  placing 
your  knee  between  his  shoulders  grasp  the  arms  near 
the  elbows,  pull  upward  and  slightly  backward,  the 
patient  breathing  .as  before. 

In  bronchial  troubles  pay  particular  attention  to  the 
anterior  portion  of  the  chest,  placing  two  fingers  be- 
tween the  ribs  parallel  to  them,  then  turn  and  press 
upward  and  outward  at  the  same  time.  This  relaxes 
the  intercostal  muscles  and  removes  irritation  to  the 
sensory  nerves. 


CHAPTER  VIII. 


ABDOMEN  AND  PELVIS. 

A  S  THE  divisions  of  the  abdomen  with  their 
•*-  •*•  contents  may  be  found  in  all  works  on 
anatomy  it  will  be  omitted  here. 

The  linea  alba,  or  central  abdominal  line,  extends 
from  the  ensiform  cartilage  to  the  symphysis  pubis. 

The  rectus  muscle  is  crossed  by  three  tendinous 
intersections  which  divide  it  into  three  portions. 
These  sometimes  cause  mistakes  in  diagnosis,  as  a 
spasmodic  contraction  of  one  of  these,  or  a  collection 
of  fluid  within  the  sheath  is  taken  for  disease  of  the 
abdominal  organs.  The  lowest  is  at  the  level  of  the 
umbilicus,  the  next  at  the  level  of  the  lower  portion  of 
the  tenth  rib  and  the  highest  at  the  ensiform  cartilage. 

The  umbilicus  is  the  most  prominent  landmark  of 
the  abdomen,  lying  in  the  middle  line,  nearer  to  the 
pubes  than  to  the  ensiform.  It  is  usually  at  the  level 
f  the  disc  above  the  third  lumbar  vertebra. 


148 

About  one  and  one-half  inches  below  the  umbilicus 
at  the  level  of  the  highest  part  of  the  iliac  crest  is  the 
bifurcation  of  the  aorta  into  the  two  common  iliac. 
Here  is  the  hypogastric  plexus. 

The  anterior  superior .  spine  of  the  iliac  is  of  great 
importance  to  the  osteopath  since  it  is  taken  as  a  fixed 
point  in  determining  the  length  of  the  limb  or  nature 
of  pelvic  or  hip  troubles.  This  point  is  of  importance 
in  diagnosing  femoral  dislocations.  The  thumbs 
placed  on  either  spine  and  the  fingers  grasping  the 
trochanters  will  easily  enable  you  to  appreciate  any 
difference  in  the  relation  of  the  two  sides. 

The  pubic  spine  is  of  importance  in  deciding  the 
nature  of  hernia  ;  the  spine  is  on  the  outer  side  of  an 
inguinal  hernia  ;  on  the  inner  side  of  a  femoral. 

Lying  one  or  one  and  one- quarter  inches  external  to 
the  spine  of  the  pubes  on  the  line  connecting  it  with 
the  trochanter  major  is  the  femoral  ring  which  is  the 
upper  end  of  the  femoral  canal.  On  account  of  the 
relation  of  the  internal  saphenous  vein  and  the 
femoral  artery  and  vein  this  canal  is  of  much 
importance. 

Just  above  and  slightly  external  to  the  spine  of  the 
pubes  is  the  external  abdominal  ring.  The  inguinal 
canal,  of  which  the  external  abdominal  ring  is  the 
inferior  opening,  extends  obliquely  downward  and 


149 
inward  almost  two  inches  fiom  the  internal  abdominal  Extema 

abdominal 

ring,  about  midway  between  the  anterior  superior  rin°' 
iliac  spine  and  the  syinphysis,  more  than  half  an  inch 
above  Poupart's  ligament.  The  external  ring 
transmits  the  round  ligament  in  the  female  and  the 
spermatic  cord  in  the  male,  two  very  important 
structures  in  osteopathic  practice.  It  is  well  to 
emphasize  a  caution  before  given,  that  the  operator  be 
careful  to  use  the  finger  tips  carefully  to  avoid  injury 
or  irritation. 

Lying  chiefly  within  the  hypochondrium,  sheltered 
by  the  ribs  and  cartilages  is  the  liver  —  the  largest 
gland  in  the  body.  It  extends  above  the  colon, 
stomach  and  duodenum,  from  the  right  hypochon- 
drium across  the  epigastric  region  into  the  left 
hypochondrium,  as  far  as  the  mammillary  line. 

The  liver  is  from  six  to  eight  inches  long,  weighing  The  uwr, 
not  far  from  five  pounds,  varying  with  the  individual, 
and  in  the  same  individual  at  different  times.  Its 
relation  to  the  digestive  and  circulatory  systems  is  a 
peculiar  one.  It  receives  an  abundant  blood  supply 
and  performs  important  changes  on  the  partly  assimi- 
lated food  stuffs.  Its  highest  point  is  on  the  right 
side,  extending  upward  to  within  an  inch  of  the 
nipple,  or  on  the  right  side  at  the  mammillary  line  it 
arises  to  the  upper  border  of  the  fifth  interspace. 


150 

The  liver  on  the  right  side  is  covered  by  the  ribs 
from  the  sixth  to  the  eleventh  inclusive.  On  the  left 
it  lies  beneath  the  cartilages  of  the  sixth  and  seventh 
ribs,  its  lower  margin  across  the  epigastrium  lying 
across  the  stomach  corresponding  to  a  line  drawn 
from  the  ejd  of  the  ninth  rib  on  the  right  to  the 
junction  of  the  seventh  on  the  left.  At  the  point 
where  the  liver  crosses  linea  alba,  half  way  from  the 
ensiform  to  the  umbilicus,  the  edge  is  easily  felt. 

Constriction  of  the  thorax  and  abdomen  by  stays 
may  result  in  displacement  of  the  liver  downward. 
Here  the  liver  lies  in  direct  contact  with  the  abdominal 
wall.  In  precussion  for  liver  dullness  it  must  be 
remembered  that  superiorly  it  is  covered  by  lung,  that 
the  phrenic  sinus  due  to  the  arching  upward  of  the 
diaphragm  is  next,  while  the  region  of  absolute  liver 
dullness  is  below  the  diaphragm.  In  the  gastric  fossa 
sometimes  loops  of  distended  intestine  lie  anterior  to 
it,  resulting  in  a  tympanitic  note.  Its  nutrient  blood 
is  from  the  hepatic  artery,  a  branch  of  the  coeliac  axis, 
while  its  functional  blood,  much  increased  during 
digestion,  comes  from  the  mesenteric  veins,  the  gastric 
and  the  splenic. 
Functions  of  Its  secretion  is  double,  an  internal  contribution  to 

liver. 

the  blood,  glycogen  and  urea  ;  an  external,  from  the 
gall  cyst  or  directly  from  the  liver  into  the  digestive 


151 

tract.  Bile  is  a  utilized  waste  product,  as  by  its  pres- 
ence in  the  intestines  it  increases  functional  activity  of 
the  tract  and  aids  in  absorption  of  fats.  The  urea 
which  it  throws  into  the  blood  stream  is  an  end  prod- 
uct of  nitrogenous  katabolism.  Glycogen  is  a  carbo- 
hydrate which  is  essential  as  a  force  former ;  the  pig- 
ments and  acids  of  the  bile  when  not  thrown  into  the 
sewage  of  the  body  act  as  harmful  substances  within 
the  blood,  affecting  the  nerve  centers,  thus  retarding 
metabolism.  Any  impairment  of  the  functions  of  the 
liver  will  result  in  the  retention  within  the  blood  of  the 
antecedent  substances  from  which  the  urea  is  formed. 
This  substance,  carbonate  of  ammonia,  acts  as  a  pow- 
erful poison  to  the  nervous  system  ;  hence  the  nervous 
disturbances  that  usually  attend  hepatic  lesions. 

Its  nerve  supply  is  from  several  sources ;  the  left 
pneumogastric  contributing  fibres  directly  to  the  liver 
from  its  distribution  over  the  lesser  curvature  of  the 
stomach.  The  solar  plexus  through  the  cceliac  plexus 
sends  fibres  along  the  hepatic  artery.  These  fibres  are 
from  three  sources,  the  right  pneumogastric,  the 
splanchnics  and  the  phrenics.  The  phrenics  are  dis- 
tributed to  the  capsule  and  to  the  superior  portion  of 
the  liver.  The  splanchnics  are  the  vaso-constrictors. 
The  vagi  furnish  vaso-dilator  fibres  and  most  likely 


152 

secretory  fibres,  though  the  existence  of  the  latter  has 
never  been  definitely  proven. 

Where  treated.  The  center  for  the  liver  is  rather  a  diffuse  one, 
though  it  is  definitely  located  between  the  ninth  and 
tenth  on  the  right  side.  The  connection  with  this  seg- 
ment is  to  be  found  in  the  splanchnics.  Again,  the 
liver  may  be  reached  through  the  solar  plexus  directly, 
or  along  the  course  of  the  hepatic  artery.  This  may 
be  reached  one  and  one-half  inches  above  the  umbili- 
cus and  about  the  same  distance  to  the  right  of  the 
middle  line.  Always  examine  the  seventh  to  the  tenth 
ribs  inclusive  as  they  may  by  pressure  cause  trouble 
with  this  organ. 

The  gall  bladder  is  normally  covered  by  liver  sub- 
stance lying  inferior  to  the  fossa  vesicalic  at  the  margin 
of  the  quadrate  lobe,  the  fundus  alone  extending  from 
beneath  its  glandular  covering,  emerging  from  its 
chondral  protection  just  at  the  level  of  the  ninth  car- 
tilage. Under  normal  conditions  the  gall  bladder  can- 
not be  felt,  though  it  may  be  if  distended.  It  is  just 
external  to  the  right  rectus  muscle. 

Since  all  the  blood  passing  through  the  coeliac  axis 
and  some  from  the  inferior  mesenteric  artery  passes 
through  the  portal  system,  it  is  clearly  seen  that  the 
liver  is  influenced  by  the  condition  of  the  circulation, 
and  also  that  any  failure  of  the  liver  to  function  would 


153 

result  in  leaving  in  the  blood  substances  whose  effects 
are  those  of  poisons. 

Our  treatment  of  the  liver  which  has  for  its  object 
the  restoration  of  function  through  its  nerve  and  blood 
supply  is  as  follows  : 

First.  Treatment  to  relieve  any  congestion  or  sub- 
luxation  in  the  liver  area,  the  ninth  and  tenth  dorsal. 

Second.  I^ocal  effects  through  the  solar  plexus 
or  branches  from  it. 

Third.     A  stimulation  of  the  pneumogastric. 

Fourth.  By  vibrating  the  thoracic  walls  over  the 
liver  with  the  heel  of  the  hand,  thus  physically  caus- 
ing a  change  in  its  circulation  and  supplying  its  cells 
with  pure  blood. 

For  sluggishness  of  the  liver  resulting  in  torpidity 
of  bowel,  the  gall  cyst  is  induced  to  empty  its  contents 
into  the  duodenum  by  pressure  on  the  fundus.  To 
accomplish  this  the  hand  is  placed  on  the  abdominal 
wall  at  the  ninth  rib,  just  external  to  the  rectus.  The 
legs  are  flexed  upon  the  abdomen,  the  patient  lying 
either  on  the  back  or  on  the  left  side.  The  patient  is 
instructed  to  take  a  deep  inspiration  and  then  as  the 
breath  is  sent  out  the  hand  follows  the  retreating  wall 
and  pressure  is  thus  put  on  the  fundus.  This  is  not  a 
mechanical  emptying  but  a  stimulus  applied  directly 
to  the  fundus,  resulting  in  a  peristalsis. 


154 

Failure  of  the  liver  to  function  may  cause  icterus, 
nervousness,  skin  eruptions,  sleeplessness,  drowsiness, 
constipation,  haemorrhoids,  etc. 

Spleen.  The  spleen  is  a  much  less  important  organ  than  the 

liver,  both  in  size  and  in  function.  It  lies,  as  we  said, 
at  the  level  of  the  tenth  rib.  Its  upper  margin  is  on  a 
level  with  the  ninth  dorsal  spine,  its  lower  with  the 
eleventh.  It  lies  in  the  infraaxillary  space,  extending 
from  the  anterior  axillary  line  to  the  posterior.  Cov- 
ered with  the  chest  wall,  it  cannot  be  felt,  save  in  case 
of  enlargement.  For  examination  the  operator  must 
rely  on  percussion,  save  in  enlargement.  In  all  infec- 
tious and  malarial  diseases  the  spleen  is  affected  and 
should  have  proper  care.  The  general  circulation 
must  be  maintained.  The  ninth  and  tenth  dorsal  on 
the  left  side  will  reach  the  spleen  through  the  sym- 
pathetic. The  right  vagus  also  contributes  to  this 
organ. 

stomach  ^ke  s^omac^1  lies  ifl  the  upper  abdominal  region  ex- 

tending from  the  left  hypochondrium  across  the  epi- 
gastrium to  the  edge  of  the  right  hypochondrium. 
This  places  about  one-sixth  to  the  right  of  the  median 
line,  five-sixths  to  the  left.  The  cardiac  opening  lies 
just  to  the  left  of  the  middle  line  opposite  the  seventh 
chondro-sternal  articulation.  The  fundus  extends  up 


155 

as  high  as  the  sixth  interspace  and  emerges  from  the 
hypochondrium  at  the  end  of  the  ninth  rib. 

In  the  median  line  in  moderate  distention  the  lower 
edge  of  the  stomach  extends  about  an  inch  lower  than 
the  liver,  one  and  one-half  inches  above  the  umbilicus. 
Arching  upward  and  to  the  right  the  pylorus  is  situ- 
ated beneath  and  behind  the  liver  opposite  the  first 
lumbar  vertebra  and  back  of  the  end  of  the  eighth  rib. 
Under  normal  conditions  the  pylorus  cannot  be  felt. 

The  fundus  lies  in  the  left  hypochondrium  and  ex- 
tends to  the  cupola  of  the  diaphragm.  Distention  may 
seriously  encroach  upon  the  thoracic  space,  leading  to 
palpitation  and  irregularity  of  heart  action,  and  short- 
ness of  breath.  This  must  be  examined  in  functional 
disturbances  of  the  heart. 

The  stomach  is  covered  anteriorly  by  the  diaphragm 
and  the  thoracic  wall  formed  by  portions  of  the  sixth, 
seventh,  eighth  and  ninth  ribs,  the  left  and  quadrate 
lobes  of  the  liver  and  the  abdominal  wall.  It  lies  an- 
terior to  the  abdominal  aorta  and  vena  cava  and  the 
coeliac  axis.  It  is  in  relation  with  the  left  kidney,  the 
spleen  and  its  vessels,  the  pancreas,  the  colon  and  part 
of  the  duodenum.  Back  of  the  stomach  lies  the  solar 
plexus  which,  to  the  osteopath,  is  its  most  important 
relation. 


156 

Blood  and  The  stomach  has  a  liberal  blood  supply  ;  from  the 

nerve  supply. 

cceliac  axis,  the  gastric;  from  the  hepatic,  the  pyloric; 

from  the  gastro-duodenalis,  branch  of  the  hepatic,  the 
gastro-epiploica  dextra ;  from  the  splenic,  the  vasa 
brevia  and  the  gastro-epiploica  sinistra.  Thus  the  en- 
tire blood  supply  is  from  the  co2liac  axis  through  its 
subdivisions  and  their  branches. 

With  the  blood  vessels  the  stomach  receives  inner- 
vation  from  the  solar  plexus,  fibres  coming  from  the 
splanchnic  and  from  the  right  pneumogastric.  In  ad- 
dition the  stomach  receives  fibres  directly  from  both 
the  right  and  left  vagi.  These  fibres  from  the  vagi 
enter  into  the  structure  of  the  walls  of  the  stomach 
and  are  supposed  to  end  within  the  fibres  of  the 
muscles.  Experiments  upon  animals  show  the  vagi  to 
be  the  nerves  of  motion  to  the  stomach,  stimulation  of 
its  peripheral  portion  after  section  resulting  in  in- 
creased movement.  But  the  fact  of  section  of  both 
vagi  does  not  mean  a  cessation  of  motion,  for  the 
stomach  will  manifest  normal  movements  after  all  ner- 
vous connections  have  been  severed.  It  may  be  that 
the  stomach  has  the  power  of  originating  motion,  —  a 
property  derived  perhaps  from  the  plexuses  of  Auer- 
bach  within  the  walls.  The  solar  plexus  contributes 
chiefly  vaso-constrictors  from  the  splanchnics,  though 
vaso-dilators  also  are  found.  The  splanchnics  entering 


157 

into  the  cceliac  plexus  also  carry  secretory,  inhibitory, 
and  sensory  fibres.  These  splanchnic  fibres  are  from 
the  fourth  to  the  eighth  dorsal  in  orgin,  though  we 
get  our  surest  effect  at  the  fourth  to  sixth  dorsal  verte- 
bra, more  accurately  between  the  fourth  and  fifth. 

The  duodenum  begins  at  the  level  of  the  first  lum- 
bar  vertebra  on  the  right  side,  lying  beneath  the  carti- 
lages of  the  false  ribs  at  the  level  of  the  sixth  inter- 
space. It  curves  upward,  backward  and  to  the  right. 
It  is  in  close  relation  with  the  liver  and  gall  cyst 
superiorly.  Above  and  posterior  to  it  run  the  hepatic 
artery,  portal  vein  and  bile  duct.  It  now  descends 
over  the  vena  cava  ascendens  and  the  right  kidney  to 
the  level  of  the  fourth  lumbar  vertebra.  It  here 
ascends  obliquely  upward  across  the  third  and  fourth 
lumbar  vertebrae,  crossing  the  vena  cava  and  aorta  to 
its  ascending  portion  lying  beside  the  aorta  and  the 
fourth,  third  and  second  lumbar  vertebrae.  The  head 
of  the  pancreas  lies  within  the  concavity  of  the  arch, 
while  the  body  lies  above  the  transverse  and  ascending 
portions.  The  terminal  portion  of  the  duodenum  lies 
behind  the  stomach  to  the  left  of  the  superior  mesen- 
teric  vessels,  and  just  at  the  inner  side  of  the  left 
kidney.  This  now  marks  the  beginning  of  the  second 
portion  of  the  small  intestine,  the  jejunum,  which 
continues  for  the  next  two-fifths  of  the  length  of  the 


158 

small  intestine,  the  remaining  portion  being  called  the 
ileum. 

The  small  intestine  as  a  whole  lies  within  the 
middle  zone  of  the  abdomen,  the  mesogastric,  practi- 
tically  filling  the  umbilical  region,  lying  anterior  to 
the  ascending  colon  in  the  right  lumbar  and  bearing 
the  same  relation  in  the  left  lumbar  to  the  descending. 
The  small  intestine  will  or  will  not  lie  in  the  pubic 
region  according  as  the  bladder  is  empty  or  distended. 
Location  and  The  mesentery,  to  which  so  much  of  the  blood  of 

Treatment  of 

the  mesenteric  artery  is  sent,  lies  almost  exclusively  in 
the  umbilical  region.  Gentle  movement  and  pressure 
here  will  quiet  pain  in  the  small  intestine. 

In  the  right  iliac  region  lies  the  caecum  and  the 
point  of  union  of  the  caecum  and  the  ileum.  Begin- 
ning at  this  point  is  the  large  intestine,  the  ascending 
portion  passing  up  through  the  right  lumbar  to  the 
inferior  surface  of  the  liver,  thence  across  the  abdo- 
men on  a  line  separating  the  umbilical  and  epigastric 
regions,  as  the  transverse  colon.  It  lies  above  the 
umbilicus  in  this  region  and  in  front  of  the  duodenum 
next  to  the  anterior  abdominal  wall.  The  descending 
colon  extends  from  the  splenic  flexure  in  the 
left  hypochondrium  downward  for  eight  inches  to 
the  iliac  crest,  at  which  point  begins  the  sigmoid  or 
omega  loop. 


159 

The  kidneys  lie  on  either  side  of  the  vertebral 
column,  anterior  to  the  transverse  processes,  extending 
from  the  upper  margin  of  the  twelfth  dorsal  vertebra 
to  the  upper  part  of  the  third  lumbar.  Covered  later- 
ally by  the  twelfth  rib  and  by  the  quadratus  lurn- 
borum  and  psoas  muscles,  palpation  will  reveal  but 
little  as  to  their  condition.  Tenderness,  muscular  con- 
traction, vertebral  and  costal  dislocations  are  the 
leading  symptoms  to  the  osteopath.  Urinary  exam- 
ination must  also  be  made. 

Above  the  kidney  on  the  left  side  is  the  spleen,  on 
the  right  the  liver.  The  nerves  to  the  kidney  come 
through  the  solar  plexus  and  chiefly  from  the  least 
splanchnic  nerve.  Some  fibres  are  derived  from  the 
aortic  plexus.  Vaso-constrictor  and  sensory  fibres 
to  the  kidney  are  from  the  eleventh  dorsal  to  the 
first  lumbar  inclusive. 

To  treat  the  kidneys  the  patient  is  placed  on  side,   Treatmentof 
facing  operator,  the  knees  and  thighs  are  flexed  and 
strong   pressure   is  applied   to  the  lower  dorsal  and 
upper  lumbar  regions,  the  spine  being  strongly  moved 
backward  and  forward  at  the  same  time. 

Another  treatment  is  strong  and  steady  pressure  at 
this  point,  the  patient  lying  on  his  face. 

Again,  the  patient  lies  on  his  back  with  legs  drawn 
up.  The  operator  puts  hands  beneath  him,  palms 


160 

upward.  Now,  with  the  patient  lying  on  finger  tips, 
the  operator  repeatedly  raises  him,  relaxing  the 
muscles,  at  the  same  time  rotating  the  legs  and  moving 
them  from  side  to  side. 

The  massive  bony  basin  which  lies  beneath  the 
abdomen  has  for  its  structure  four  bones  compactly 
put  together,  the  sacrum,  the  ilium,  the  ischium  and 
the  pubes.  This  constitutes  the  pelvis. 

The  plane  passing  through  the  upper  margin  of 
the  symphysis,  linea  ilio-pectinea  and  the  sacral  promi- 
nence divides  this  basin  into  two  portions  ;  the  part 
above,  the  false  pelvis,  and  the  part  below,  the  true 
pelvis.  The  false  pelvis  is  in  position  and  function  a 
portion  of  the  abdominal  cavity,  serving  to  hold  the 
weight  of  the  intestines  from  the  pelvic  organs.  The 
anterior  boundary  is  between  the  widely  separated  iliac 
spines  closed  by  abdominal  parieties. 

This  region,  which  is  really  a  portion  of  the  hypo- 
gastrium,  is  bounded  laterally  by  the  ossa  ilii  and 
contains  part  of  the  intestine ;  the  bladder  in 
distention,  and  the  uterus  in  pregnancy,  extend  up 
into  this  region. 

Opening  through  the  abdominal  or  pelvic  wall, 
just  above  and  to  the  outer  side  of  the  crest  of  the  os 
pubis,  is  a  hiatus  in  the  external  oblique  muscle  called 
the  external  abdominal  ring.  This  opening  lies  above 


161 

and  internal  to  Poupart's  ligament  at  its  insertion  into 
the  pubic  spine,  extending  about  an  inch  upward  and 
outward  from  a  point  between  the  spine  and  sym- 
physis.  This  opening  transmits  the  spermatic  cord  or 
the  round  ligament,  according  to  sex. 

The  points  of  importance  to  the  osteopath  are 
these :  An  inch  lateral  to  the  lumbo-sacral  articula- 
tion just  above,  and  median  to  the  posterior  superior 
spine  is  the  posterior  sacro-iliac  ligament.  The 
lumbo-sacral  articulation  is  itself  one  of  the 
weak  portions  of  the  spine.  Here,  in  case  of  slip,  strain 
or  dislocation,  will  be  found  marked  tenderness.  One 
and  one-half  inches  below  and  three-fourths  of  an  inch 
lateral  to  this  point  is  the  lower  and  posterior  portion 
of  auricular  articulation,  below  the  posterior  superior 
spine.  Tenderness  here  is  indicative  of  a  slip  of  the 
ilium  upon  the  sacrum.  An  inch  below  this  is  the 
great  sacro-sciatic  notch,  lying  under  the  posterior 
inferior  spine  of  the  ilium.  About  two  inches  below 
the  inferior  iliac  spine  is  the  ischiatic  spine,  which 
with  the  lesser  sciatic  ligament  attached  to  it  converts 
the  greater  sciatic  notch  into  a  foramen  and  separates 
it  from  the  lesser  notch  below. 

The  pyriforinis  muscle  passes  through  the  greater 

muscle. 

notch  and  attaches  to  the  great  trochanter.  This  is  a 
very  important  structure.  Above  this  muscle  pass 


162 

out  the  gluteal  artery  and  vein  and  the  superior  glu- 
teal  nerve  ;  through  this  notch,  below  the  muscle,  pass 
the  two  sciatic  nerves,  the  sciatic  vessels,  the  internal 
pudic  vessels  and  the  pudic  nerve.  The  pudic  nerve 
passes  over  the  spine  and  re-enters  the  pelvis  through 
the  lesser  notch.  This  nerve  is  distributed  to  the 
penis  or  clitoris,  to  the  rectum  and  to  the  perinaeuin. 

The  pyriformis,  the  gemelli,  the  obturator  and 
the  quadratus  femoris  muscles  may  all  be  relaxed  by 
internal  rotation  of  the  thigh,  accompanied  by  pressure. 
This  will  be  useful  in  rheumatism  of  the  muscles  of  the 
hip,  in  sciatica  and  in  vaso-motor  or  circulatory  dis- 
turbances in  the  limb. 

The  ischiatic  tuberosity  is  to  the  side  of  the  anal 
opening  and  can  be  plainly  felt.  Half  way  between 
this  point  and  the  trochanter  major  the  great  sciatic 
nerve  may  be  compressed. 

The  coccyx  can  always  be  felt  just  above  the  anus. 
It  is  important  that  it  be  in  correct  position  as  it  is 
frequently  the  cause  of  constipation,  coccygodynia,  etc. 
It  can  be  best  examined  per  rectum. 

The  anterior  bony  prominence  is  the  pubic  spine 
nearly  an  inch  lateral  to  the  symphysis.  It  should 
not  be  sensitive  to  pressure,  but  if  there  be  a  slip  of  the 
ilium  on  the  sacrum  there  will  be  marked  tenderness 


163 

at   symphysis.      Also  one  side  Will   be    elevated   or 
depressed  as  the  case  may  be. 

The  ischio-rectal  fossa  lies  between  the  anus  and  the 
tuberosity  of  the  ischium.  In  this  the  osteopath  reaches 
the  levator  ani,  sphincter  ani,  the  coccygeus  muscles, 
fascia  covering  important  structures,  the  walls  of  the 
rectum,  the  posterior  wall  of  the  vagina,  the  pudic 
nerve  and  vessels  and  their  branches. 

The  ischio-rectal  fossa  is  also  treated  by  insertion 
of  the  finger  into  the  rectum.  Here,  too,  may  be 
treated  the  prostate  gland  and  the  membranous 
urethra.  The  lower  and  upper  sphincters  may  be 
reached  and  dilated  and  a  stimulation  applied  to  the 
rectal  wall.  Treatment  per  rectum  should  not  be 
given  more  often  than  once  per  week,  except  in  rare 
cases.  Rectal  examination  will  reveal  much  as  to  the 
position  of  the  uterus.  Vaginal  examination  will 
detect  the  urethra  along  its  anterior  wall,  the  rami  of 
the  pubes  and  ischia.  The  ovary  cannot  be  felt  either 
per  vagina  or  through  the  pubic  region  unless  pro- 
lapsed or  enlarged.  They  lie  two  inches  on  either 
side  of  the  middle  line  of  the  body  and  about  the  same 
distance  above  the  pubic  crest. 


CHAPTER  IX. 


THE  LIMBS. 

f~  I^VHE  shoulder  is  to  the  osteopath  an  important 
-*•  articulation.  The  arm  is  used  in  many  of  the 
movements  which  the  operator  administers.  Owing 
to  the  multiform  uses  of  the  arm  and  hand,  the  shoulder 
is  called  into  actions  varied  and  constant,  so  that 
strains  and  dislocations  are  of  frequent  occurrence, 
while  the  massive  musculature  is  prone  to  deposit  the 
product  of  destructive  metabolism  within  the  tissues 
which  go  to  perfect  its  motion.  From  strains,  colds 
and  rheumatism,  the  shoulder  suffers  more  often  than 
any  other  joint. 

The  clavicle  extends  in  an  almost  horizontal  position 
from  the  manubrium  sterni  to  the  acromion  process 
where  usually  the  acromio-clavicular  joint  forms  an 
almost  even  plane,  but  there  may  be  a  noticeable 
enlargement  of  the  acrornial  end  of  the  clavicle  or  an 
increase  of  the  fibro-cartilage  in  the  joint.  This 


165 

prominence  is  often  mistaken  for  a  dislocation  or  for  a 
clavicular  fracture.  On  the  other  hand  a  dislocation 
is  often  mistaken  for  this  projection.  When  in  doubt 
compare  carefully  with  other  shoulder.  The  three 
chief  landmarks  are,  (r)  the  union  of  the  scapular 
spine  with  the  acromion  process,  a  fixed  point  from 
which  to  measure  the  relative  lengths  of  the  arms  ;  (2) 
the  coracoid  process  about  two  inches  anterior  to  this, 
and  (3)  the  greater  and  lesser  tuberosities  of  the 
humerus. 

The  greater  tuberosity  faces  in  the  direction  of  the 
external  condyle  ;  the  lesser  in  the  normal  position 
of  the  arm  lying  somewhat  in  front  and  toward  the 
median  line  of  the  body.  The  bicipital  grove  may  be 
felt  on  deep  pressure  lying  between  the  tuberosities, 
extending  downward  marking  the  direction  of  the 
biceps  muscle.  The  head  of  the  humerus  can  be  felt 
above  the  axillary  space.  If  low  in  the  axillary 
space,  or  below  and  in  front  of  the  coracoid  process,  or 
behind  on  the  back  of  the  scapula  below  the  acromion, 
it  is  dislocated.  Great  care  must  be  used  in  diagnos- 
ing a  dislocation  as  sometimes  a  fracture  may  be 
overlooked.  Crepitation,  freedom  of  movement  and 
holding  the  head  of  the  humerus  while  the  arm  is 
moved  will  aid  in  differentiating  between  these  con- 
ditions. 


166 

The  clavicle  is  attached  to  both  the  sternum  and  the 
cartilage  of  the  first  rib  by  ligaments  which  allow  of 
motion,  though  limited,  in  all  directions,  and  is  the  cen- 
ter of  all  movements  of  the  shoulder.  It  passes  high 
above  and  internal  and  posterior  to  the  coracoid  process, 
to  which  it  is  bound  by  the  coraco-clavicular  ligament. 
The  clavicle  is  firmly  bound  to  the  acromion,  yet  in 
such  a  way  as  to  permit  either  bone  to  move  on  the 
other,  the  clavicle  gliding,  the  scapula  rotating  on  the 
clavicle.  This  articulation  sometimes  becomes  the 
seat  of  acute  pains  which  manifest  themselves  in  eleva- 
tion of  the  shoulder.  This  joint  is  supplied  by  the 
suprascapular  nerve.  The  nerves  to  the  shoulder 
joint  are  the  suprascapular  and  the  circumflex,  from 
the  brachial  plexus. 

The  muscles  which  connect  the  arm  with  the  trunk, 
with  which  the  osteopath  is  most  especially  concerned, 
are  the  following  :  The  pectorales  major  and  minor 
and  the  subclavius  which  are  useful  in  ordinary 
movements  of  the  arm  and  shoulder,  yet  their  use  is 
much  magnified  by  the  osteopathic  practitioner. 
These  three  muscles  all  attach  to  the  ribs,  the 
subclavius  to  the  first,  the  pectoralis  minor  to  the 
third,  fourth  and  fifth,  while  the  major  embraces  the 
clavicle,  sternum  and  cartilages  of  the  ribs  to  the 
seventh,  thus  giving  the  ideal  leverage  on  the  ribs  for 


167 

drawing  them  up  and  expanding  the  chest.  In  case 
any  of  the  first  six  or  seven  ribs  are  deflected  these 
muscles  are  used  in  replacing  them,  by  drawing  the 
arm  upward,  outward  and  backward,  pressing  at  the 
same  time  on  the  angle  of  the  ribs.  The  nerves  of 
the  pectoral  muscles  pass  inward,  the  external  crossing 
the  axillary  artery,  the  internal  lying  between  it  and 
the  vein  and  both  passing  across  the  pectoralis  minor  ; 
the  external  piercing  the  costo-coracoid  membrane, 
thence  between  the  muscles  and  thus  lying  by  its 
branches  both  below  and  above  the  pectoralis  minor. 

The  blood  supply  to  the  pectoral  region  is  from  the 
superior  thoracic,  thoracic  branch  of  the  acromial 
thoracic  and  the  long  thoracic  together  with  the 
subscapular.  These  are  all  branches  from  the  axillary 
artery  and  may  be  reached  in  the  axillary  space 
beneath  the  pectoralis  muscle. 

The  costo-coracoid  membrane  covers  the  space  Costo.coracoid 
between  the  clavicle  above,  the  pectoralis  minor  below, 
the  coracoid  process  externally  and  the  first  rib 
internally  ;  these  points  being  its  attachments.  The 
anterior  thoracic  nerves  may  both  be  reached  here  as 
may  the  acromial  thoracic,  the  superior  thoracic 
vessels  and  the  cephalic  vein.  The  last  is  useful  in 
drainage  of  the  arm. 


168 

The  deltoid  muscle  raises  the  arm  at  right  angles 
laterally  to  the  trunk  and  together  with  the  teres 
minor  receives  the  circumflex  nerve.  The  teres  minor 
can  be  reached  in  the  posterior  scapular  region, 
extending  from  the  scapula  to  the  lowest  facet  of 
the  humerus.  This  muscle  rotates  the  humerus  out- 
ward and  with  the  major  and  the  supraspinatus  pro- 
tects the  joint  from  anterior  dislocation. 

The  circumflex  nerve  which  supplies  the  deltoid  and 

The  deltoid 

the  teres  minor  is  distributed  to  the  joint  and  to  the 
skin  covering  it.  It  crosses  the  quadrilateral  space 
formed  by  the  long  head  of  the  triceps  internally,  the 
neck  of  the  humerus  externally,  the  teres  minor  above 
and  the  major  below.  Here  it  may  be  reached  either 
anteriorly  or  posteriorly.  The  branches  are  upper  and 
lower,  the  lower  may  be  reached  at  the  posterior 
margin  of  the  deltoid,  the  upper  at  the  anterior.  This 
nerve  is  frequently  involved  in  case  of  trouble  at  the 
shoulder. 

The  two  spinati  muscles  which  insert  into  the  upper 
and  middle  facets  of  the  humeral  head,  act  with  the 
deltoid  and  the  teres  minor.  The  supraspinatus  in 
elevating  the  arm,  the  infraspinatus  in  rotating  the 
humerus  outward.  The  suprascapular  nerve  coming 
from  the  fifth  and  sixth  cervical  supply  those  muscles, 
while  it  also  distributes  branches  to  the  shoulder  and 


169 

to  the  claviculo-acromial  articulation.  This  nerve 
enters  the  supraspinatus  fossa  at  the  suprascapular 
notch  and  crossing  the  fossa  passes  beneath  the 
acromial  end  of  the  spine  to  the  infraspinatus  muscle. 
It  may  be  reached  either  at  its  origin  or  as  it  crosses 
the  fossa  beneath  the  trapezius  and  the  supraspinatus 
muscles. 

The  subscapularis  muscle  passes  from  the  ventral 
surface  of  the  scapula  and  serves  as  a  guard  against 
anterior  dislocation  of  the  humerus  by  inserting  into 
the  lesser  tuberosity.  Its  nerve  supply  is  in  common 
with  the  teres  major  and  the  latissimus  dorsi,  derived 
from  the  subscapular  nerves.  These  nerves  come 
from  the  fifth  to  the  eight  cervical  and  may  be  reached 
at  their  origin  or  at  the  posterior  border  of  the  axilla. 

By  means  of  the  arm  and  shoulder  the  osteopath 
obtains  leverage  upon  the  entire  vertebral  column.  Levera^e- 
Through  the  latissimus  dorsi  on  the  lower  dorsal  and 
lumbar,  through  the  teres  and  subscapularies  by  the 
rhomboids  he  puts  stress  upon  the  upper  dorsal.  The 
levator  anguli  scapula  connects  the  shoulder  with  the 
cervical  region. 

The  rhomboids  are  innervated  from  the  fourth  and 
fifth,  or  from  the  trunk  of  the  fifth  just  before  the 
cord  is  formed  ;  the  levator  anguli  scapulae  gets  the 
third  cervical. 


170 

The  important  muscles  of  the  shoulder  joint  are  the 
biceps,  coraco-brachialis  and  triceps.  The  inner  mar- 
gin of  the  coraco-brachialis  lying  almost  parallel  with 
the  axillary  artery.  The  long  head  of  the  biceps  lies 
in  the  bicipital  groove,  is  attached  to  the  supra-glenoid 
tubercle  and  is  thus  closely  related  to  the  joint,  being 
easily  involved  in  troubles  of  the  shoulder.  Its  loca- 
tion may  be  determined  by  the  two  tuberosities  be- 
tween which  it  lies.  The  median  nerve  and  the 
brachial  artery  lie  along  the  inner  margin  of  the  coraco- 
brachialis  and  the  biceps,  the  median  lying  first  exter- 
nal and  then  crossing  the  artery  in  its  middle  course. 
The  ulnar  nerve  lies  about  an  inch  internal  to  the 
median,  almost  parallel  to  it,  leaving  it  at  the  elbow  ; 
the  median  at  first  passing  beneath  the  bicipital  fascia 
to  the  middle  of  the  forearm.  The  basilic  vein  lies 
between  the  artery  and  the  ulnar  nerve,  a  fact  to  be 
remembered  as  this  vein  is  useful  in  drainage. 

The  elbow  is  the  seat  of  much  trouble,  lack  of  mo- 
tion, displacement,  etc.  The  outer  and  inner  condyles 
are  easily  located,  while  the  olecranon  process  of  the 
ulna  comes  on  a  level  with  those  two  points  when  the 
arm  is  extended.  Place  the  thumb  on  one  condyle, 
the  middle  finger  on  the  other  and  the  index  finger  on 
the  olecranon.  Ulnar  dislocation  would  destroy  these 
relations.  The  olecranon  is  nearer  the  inner  than'  the 


171 

outer  condyle.  Between  the  olecranon  and  the  inner 
condyle  is  a  depression  which  conveys  the  ulnar  nerve 
—  the  funny  bone  of  the  laity.  External  to  the  olec- 
ranon is  a  well  marked  depression  lying  just  below 
the  external  condyle.  This  is  one  of  the  most  im- 
portant landmarks,  since  deep  within  it,  external  to 
the  supinator  longus  and  the  extensor  carpi  radialis 
may  be  felt  the  head  of  the  radius  moving  in  pronation 
and  supiuation.  This  is  a  guide  in  determining  dislo- 
cation of  the  radius.  The  lymphatics  of  the  elbow 
usually  are  the  first  to  manifest  excitation  if  poisons 
are  absorbed  through  wounds  of  the  hand, — a  small 
gland  just  above  the  internal  condyle  usually  first 
showing  this  condition.  The  musculo-spiral  nerve 
winds  around  the  arm  and  becomes  anterior  above  the 
external  condyle. 

The  simplicity  of  structure  of  the  arm  makes  this  a 
very  easily  studied  articulation.  The  biceps,  the 
brachialis  anticus  and  the  supinator  longus  are  the 
chief  muscles  of  flexion  of  the  forearm.  The  triceps 
is  the  chief  extensor,  the  anconeus  which  may  be  con- 
sidered as  a  portion  of  the  triceps,  assisting.  The  two 
supinators  are  innervated  by  or  from  the  musculo- 
spiral,  the  pronators  by  the  musculo-cutaneous. 

The  usual  dislocation  at  the  elbow  is  one  or  both 
bones  backward  or  else  both  forward  ;  the  former  when 


172 

the  forearm  is  extended,  the  latter  when  flexed.  lat- 
eral displacement  is  rare.  The  usual  method  of  reduc- 
ing such  dislocation  is  by  a  direct  pull,  the  knee  may 
be  placed  at  the  bend  of  the  elbow,  and  straightening 
the  arm,  at  the  same  time  exercising  great  force  so  as 
to  overcome  the  dislocation. 

The  wrist  is  frequently  the  seat  of  synovitis  arising 
from  rheumatic  troubles  or  from  pyaemia.     Distention 
of  the  synovial  sack  causes  fullness  over  the  back  of 
the  wrist.     The  styloid  processes  are  the  guides  to  the 
wrist,  that  of  the  radius  extending  downward  farther 
than  the  ulna.     There  is  a  bony  furrow  on  the  back 
part  of  the  radius  which  transmits  the  tendon  of  the 
extensor  longus  pollicis  muscle.      This  is  the  place  of 
examination  in  case  of  Colles  fracture  of  the  radius. 
In  case  of  radial  fracture  the  styloid  process  of  the 
radius  will  be  on  a  level  with  or  above  the  styloid  of 
the  ulna.     The  scaphoid  tubercle  may  be  distinguished 
just  below  the  radius,  the  articulation  of  these  bones 
lying  between  these  points.     The  trapezium  lies  just 
below  and   articulates    with    the    metacarpal  of  the 
thumb.     The  pisiform  bone  may  be  felt  just  below  the 
ulnar  styloid,  the  unciform  lying  within.     The  tendons 
of  the  wrist  are  important.     The  extensors  may  be 
traced,  using  each  alternately,  the  three  extensors  of 
the  thumb  lying  on  the  outer  side  of  the  wrist.     The 


173 

flexor  carpi  radialis  tendon  is  a  guide  to  the  radial 
artery. 

The  hip  is  related  to  many  important  structures 
which  bear  upon  the  physiology  of  the  limb.  You  will 
recall  some  points  referred  to  in  the  preceding  chapter, 
namely,  the  symphysis  pubes  and  the  spine  of  the 
pubes  which  lies  external  to  the  symphysis  on  the 
same  level  as  the  upper  part  of  the  trochanter  major 
About  one  and  one-half  inches  external  to  this  is  the  Sapnenous 

,  .  ,  .   ,  r  ,    Opening. 

saphenous    opening,    a    point    at    which    a    femoral 

hernia  first  makes  its  appearance.  The  point  is  just 
below  Poupart's  ligament.  Its  chief  importance  to  the 
osteopath  lies  in  its  relation  to  the  drainage  of  the  leg 
The  femoral  ring  is  half  an  inch  higher  than  the 
saphenous  opening.  Find  the  pulsation  of  the  iliac 
artery,  pass  toward  the  median  line  one-half  inch 
from  the  iliac  vein  and  next  is  the  femoral  opening  or 
ring.  The  anterior  superior  spine  of  the  ilium  is  an- 
other point  of  interest  as  being  the  fixed  point  of  meas- 
urement in  case  of  suspected  dislocation. 

The  trochanter  major  is  a  prominence  which  cannot 
be  missed.  It  is  covered  by  the  skin  and  by  the  fascia 
of  the  gluteus  maximus.  The  head  of  the  femuris 
about  three-fourths  of  an  inch  above  the  level  of  the 
pubic  spine,  in  all  positions  looking  in  the  direction  of 
the  inner  condyle.  Great  care  is  necessary  in  diag- 


174 

nosis  of  femoral  dislocations.  The  osteopath  must 
bear  in  mind  the  fact  that  even  partial  or  complete  dis- 
location may  be  the  result  of  tubercular  processes. 
Motion  in  such  cases  is  a  positive  injury,  though  treat- 
ment may  be  effective  if  directed  toward  the  blood  and 
nerve  supply.  In  dislocation  the  ilio-femoral  liga- 
ment, the  most  resistant  portion  of  the  capsular, 
determines  largely  the  position  of  the  hip. 
Test  for  To  detect  dislocation  the  patient  should  be  lying 

dislocated  hip. 

straight,  face  upward ;  place  the  thumbs  on  the 
anterior  superior  spines  of  the  ilia.  A  comparison  of 
the  two  sides  is  usually  the  surest  way  of  determining 
relative  positions  of  the  parts.  Nelaton's  line  is  use- 
ful. It  is  a  line  from  the  anterior  superior  spine  to 
the  tuberosity  ischii.  On  this  line  lies  the  center  of 
the  acetabulum  and  at  the  same  level  as  the  trochanter 
major.  The  femur  may  be  dislocated  in  any  direction; 
backward,  either  above  the  dorsum  ilii,  or  below  the 
obturator  internus  muscle  into  the  sacro-sciatic  notch, 
or  it  may  be  anterior  on  the  pubes  or  inferior  into  the 
obturator  or  thyroid  foramen. 

The  chief  muscles  which  serve  as  landmarks  around 
the  hip  are  the  glutei,  the  sartorius  and  the  adductor 
longus.  Raising  the  leg  will  throw  the  sartorius  and 
adductor  longus  into  relief,  thus  outlining  Scarpa's 
triangle. 


175 

Between  the  ischiatic  tuberosity  and  the  greater 
trochanter  may  be  reached  the  sciatic  nerve,  lying 
close  to  the  femur.  It  may  be  followed  down  the 
thigh,  where  it  divides  into  popliteal  branches  above 
the  popliteal  space.  This  nerve  supplies  the  hamstring 
muscles,  the  adductor  magnus  and  some  branches  to 
the  hip  joint,  while  some  fibres  from  both  its  popliteal 
branches  are  distributed  to  the  knee. 

The  obturator  nerve  may  be  reached  just  below  the  Obturator 

nerve. 

pyriformis  internal  to  the  sciatic.  This  nerve  supplies 
the  acetabulutn  and  also  the  teres  ligament  and  in 
common  with  the  sciatic  and  the  anterior  crural  nerve 
is  distributed  to  the  knee  on  its  inner  side.  It  is  one 
of  the  three  nerves  affected  when  trouble  at  the  hip  is 
indicated  by  pain  at  the  knee.  The  adductors  and 
gracilis  are  innervated  by  this  nerve. 

The  femoral  artery  which  supplies  the  thigh  and  leg 
may  be  followed  to  the  knee  by  a  line  drawn  from  the 
middle  of  Poupart's  ligament  to  the  adductor  tubercle 
on  the  inner  condyle. 

The  patella  can  be  felt  on  the  anterior  of  any  knee, 
its  tendon  lying  in  a  vertical  plane.  This  tendon,  a 
continuation  of  the  extensor  tendons  of  the  leg,  lies  in 
the  line  continued  through  the  tubercle  of  the  tibia, 
drawn  from  the  middle  point  of  the  ankle.  The 
sy  no  vial  sac  lies  beneath  the  patellar  ligament  one- 


176 

half  its  length,  while  it  rises  above  the  patella  two 
inches,  slightly  higher  beneath  the  vastus  internus 
than  the  vastus  externus. 

The  condyles  of  the  femur  and  the  tubercle  of  the 
tibia  to  which  the  ligaraentum  patella  is  attached  are 
prominent  points.  The  head  of  the  fibula  lies  at  the 
level  of  the  insertion  of  the  patellar  ligament,  on  the 
outer  side,  the  tubercle  of  the  tibia  on  the  inner  side. 

The  ligamentous  structures  of  the  knee  are  compli- 
cated and  liable  to  injury.  The  external  are  the  only 
ones  which  are  palpable  and  their  positions  should  be 
remembered. 

The  patella  has  been  mentioned.  The  posterior 
extends  across  the  floor  of  the  popliteal  space.  The 
internal  reaches  from  the  tuberosity  on  the  inner  con- 
dyle  of  the  femur  to  that  of  the  tibia,  being  crossed 
by  the  inner  hamstrings ;  the  short  external  extends 
behind  the  external  from  the  condyle  to  the  styloid 
process  of  the  fibula.  Beneath  the  external  lateral 
ligaments  pass  the  external  articulate  vessels  and 
nerves. 

The  nerves  are  from  the  external  and  internal  popli- 
teal branches  of  the  sciatic,  from  the  anterior  crural 
and  the  obturator. 

Its  vascular  supply  is  abundant  and  may  be  utilized 
in  case  of  effusion  around  the  joint.  The  tendons  of 


177 

muscle  around  the  joint  are  :  The  quadratus  femoris, 
anteriorly ;  internally  and  posteriorly,  sartorius, 
gracilis,  semi-membranosus  and  semi-tendinosus  which 
are  inserted  into  the  inner  aspect  of  the  tibia. 

The  biceps  tendon  is  related  to  the  external  lateral 
ligament  and  is  attached  to  both  tibia  and  fibula,  the 
ilio-tibial  band  passing  anterior  to  it  to  be  inserted 
into  the  head  of  the  tibia.  The  popliteal  space  offers 
the  point  for  effecting  both  superficial  and  deep  drain- 
age of  knee  and  leg  through  the  popliteal  and  short 
saphenous  veins.  Locking  of  the  knee  in  extension  is 
due  oftentimes  to  shortening  of  these  cords,  sometimes 
due  to  misplacement  of  the  semilunar  fibro-cartilages 
of  the  knee. 

The  two  prominent  landmarks  of  the  ankle  are  the  Landmarks  of 

the  anhle. 
two  malleoli,   the  inner  longer  and  lower   than   the 

outer.  Back  of  the  inner  malleolus  may  be  reached 
the  posterior  tibial  nerve,  a  continuation  of  the 
internal  popliteal,  the  posterior  tibial  artery  and  the 
short  saphenous  vein. 

The  anterior  tibial  artery  and  nerve  lie  between  the 
tibia  and  the  fibula  anteriorly,  passing  beneath  the 
annular  ligament  between  the  tendons  of  the  flexor 
proprius  hallucis  internally  and  the  flexor  longus 
digitorum. 


178 

The  tendons  around  the  ankle  are :  The  ten  do- 
achillis  prominent  behind  ;  external  to  this  the  two 
peroneii,  while  internal  to  it  behind  the  inner  malleolus 
we  find  tendons  of  the  tibialis  posticus,  flexor  longus 
digitorum  and  the  flexor  longus  hallucis.  On  the 
front  of  the  ankle  are  the  four  tendons  which  extend 
to  the  foot  and  the  toes.  The  sciatic  nerve  innervates 
all  the  muscles  of  the  leg  and  the  foot  through  its 
branches  or  sub-branches. 

The  popliteal  artery  divides  into  the  anterior  and 
the  posterior  tibial  an  inch  and  a  half  below  the 
popliteal  space,  the  anterior  passing  between  the  bones 
anteriorly  and  the  posterior  continuing  down  the 
middle  line  of  the  leg. 

In  rheumatic  affections  of  the  knee  or  the  ankle  or 
in  strains  of  these  articulations  the  nerves  must  be 
carefully  treated.  The  drainage  must  be  watched  in 
all  cases  in  which  effusion  is  a  condition.  This  is 
secured  by  manipulation  of  the  muscles,  by  pressure 
over  the  deep  nerves,  and  by  tracing  the  superficial 
veins,  giving  particular  attention  to  the  saphenous 
opening. 


CHAPTER  X. 


GYN ECOLOGY  AND  OBSTETRICS. 

OUR  race  is  entitled  to  a  healthier  motherhood. 
In  eliminating  drugs  and  substituting  a  rational 
method  of  treatment,  Osteopathy  has  contributed  much 
to  this  end.  In  pelvic,  even  more  prominently  than  in 
other  diseases,  is  the  rationale  of  osteopathic  treatment 
brought  into  view. 

Take  off  the  pressure.  Remove  the  stasis.  Replace 
and  strengthen  the  organs.  Nature  will  restore  health 
and  vitality  if  she  have  the  opportunity.  No  matter 
what  condition  the  disease  of  the  pelvic  organs  may 
have  assumed,  there  is  too  much  blood  there,  for  con- 
tinued over-stimulation  of  the  vaso-constrictors  would 
soon  result  in  a  weakness  of  both  nerves  and  vascular 
walls  and  a  consequent  engorgement.  Always  too 
much  blood, —  hyperaemia.  This  results  in  a  stasis, 
but  still  too  much  blood.  Moving  blood  is  health. 
Stasis  reduces  the  nutritive  properties  of  the  blood, 
creases  its  percentage  of  waste  products,  deteriorates 


180 

the  vascular  walls  and    produces    transudation   and 
oedema. 

This  increase  of  local  fluid  is  an  irritant  to  the  nerve 
endings  and  the  organs  are  excited  to  a  condition  of 
pain.  This  condition  now  results  in  a  morbid  metab- 
olism, either  constructive  as  growths,  enlargements, 
and  tumors ;  or  to  breaking  down  of  tissue  through 
retrograde  metabolism,  as  in  ulcerations. 

In  almost  all  cases  of  pelvic  disturbances  leucorrhcea 
is  a  preceding  condition,  an  unmistakable  sign  of 
hypersemia,  venous  stasis,  and  decreased  vitality  of 
vascular  walls.  This  fluid  should  be  returned  by 
nature's  conduits,  the  veins,  designed  to  carry  back 
the  products  of  oxidation  in  the  tissues.  If  there  be 
pressure  on  the  venous  channels  anywhere  between 
pelvis  and  heart  then  will  this  exudation  be  present. 
But  this  pressure  to  the  veins  is  not  the  only  factor 
which  may  disturb  the  vitality  of  the  pelvic  organs. 
Closely  related  as  they  are  with  the  sympathetic  ner- 
vous system  and  with  the  cerebro-spinal  both  directly 
and  indirectly,  the  pelvic  organs  are  the  servants  of  the 
nervous  system.  Any  change  in  their  positions  may 
irritate  an  afferent  nerve  and  reflexly  interfere  with 
their  nutrition  and  function. 

But  this  is  not  all.  Any  change  that  may  occur 
along  the  pathway  of  these  nerves  will  produce  the 


181 

same  effect.     The  pelvic  organs  are  innervated  by  the  Innervati0n 

of  the  pelvic 
nerves  making  their  exit  from  the  lumbar  and  from  organs. 

the  sacral  portions  of  the  spinal  canal,  and  from  the 
hypogastric  plexus  lying  over  the  body  of  the  fifth 
lumbar  vertebra. 

The  nerves  to  the  ovary  come  from  the  uterus  along 
the  Fallopian  tubes  while  another  pathway  is  from  the 
ovarian  plexus,  derived  from  the  aortic  plexus,  thus 
related  to  the  lower  portion  of  the  solar  plexus.  The 
hypogastric  plexus  also  receives  fibres  from  the 
lower  dorsal  thus  connecting  these  organs  with  the 
lower  dorsal  and  upper  lumbar  spinal  segments. 

The  arterial  supply  to  the  pelvic  viscera  is  from  the 
aorta  via  the  ovarian  and  from  the  internal  iliac  via 
the  uterine,  drainage  being  effected  into  corresponding 
veins. 

In  position  the  uterus  extends  from  fundus  a  little 
below  the  brim  of  the  pelvis,  slightly  to  the  right  of 
the  middle  line  to  the  upper  portion  of  the  vagina  into 
which  the  cervix  projects,  meeting  it  normally  at  a 
right  angle  or  greater.  The  condition  of  the  bladder 
and  rectum  will  affect  the  position  of  this  organ. 

The  Fallopian  tubes  extend  from  the  highest  point 
of  the  uterus  laterally,  lying  below  the  level  of  the  sacral 
promontory,  enwrapped  in  the  broad  ligament.  They 
are  from  three  to  five  inches  in  length  lying  over  and 


182 

around  the  ovaries.  The  latter  bodies  are  about  one 
and  one-half  inches  long,  one  inch  broad  and  one-half 
inch  thick,  and  lie  in  the  broad  ligament.  They  lie 
just  within  the  true  pelvis  at  the  side  of  the  uterus  and 
cannot  normally  be  palpated  through  the  abdominal 
wall.  Their  blood  supply  is  derived  from  the  ovarian 
artery,  their  nerves  from  the  hypogastric  plexus. 
Examination.  Examination  of  the  pelvic  organs  can  be  made  in 
many  cases  and  cures  be  affected  without  a  vaginal  ex- 
amination. This  is  often  true  in  cases  of  young  girls. 
The  examination  should  first  be  directed  to  the  spine 
in  the  following  regions  :  the  ninth  to  eleventh  dorsal, 
the  first  to  third  lumbar,  the  lumbo-sacral  articulation, 
the  sacro-iliac  synchondroses  and  the  second  and  third 
sacral  nerves. 

In  addition,  the  fifth  lumbar  is  almost  invariably 
affected,  either  primarily  disturbing  the  hypogastric 
plexus  or  reflexly  from  it. 

For  a  local  examination  the  patient  should  be  on  her 
back,  the  legs  flexed.  The  body  of  the  patient  should 
be  covered.  For  examination  the  hand  should  be 
carefully  cleaned  and  rendered  aseptic,  and  slightly 
coated  with  some  non-irritating  substance.  Should  it 
become  necessary  to  examine  a  virgin  the  greatest  care 
must  be  taken  to  avoid  rupturing  the  hymen.  Often 
an  imperforate  hymen  may  be  the  cause  of  trouble. 


183 

The  left  hand  should  be  used  to  depress  the  uterus 
through  the  anterior  abdominal  wall.  Carefully  notice 
the  position  of  the  uterus.  In  ordinary  cases  the  in- 
dex finger  should,  without  force,  reach  the  uterus  as  it 
extends  into  the  vagina.  Should  it  be  too  close  to  the 
vaginal  entrance  there  is  prolapse.  The  direction  of 
the  os  and  cervix  will  determine  whether  the  uterus  is 
tipped  anteriorly,  posteriorly  or  laterally  ;  called  ante- 
version,  retro- version  and  latero- version. 

Should  the  fundus  be  bent  upon  the  cervix  the  cor- 
responding flexion  prevails.  An  examination  with 
speculum  and  sound  is  often  necessary. 

Should  any  of  these  conditions  be  present  it  is  an 
indication  of  the  presence  of  too  much  blood  of  an  in- 
ferior quality.  Pain  and  irritation  have  called  too  much 
blood  to  the  parts ;  stasis  has  caused  its  quality  to 
deteriorate.  Local  applications  are  useless.  Pessa- 
ries and  supports  are  in  no  sense  correctives.  The 

Treatment. 

treatment  consists  in  correcting  the  disturbances  in 
some  of  the  following  locations  :  The  muscles,  liga- 
ments and  vertebrae  in  the  lower  dorsal  and  lumbar 
regions  should  be  made  normal.  An  inpacted  sigmoid 
and  rectum  may  cause  trouble  to  the  uterus  itself  or  to 
the  hypogastric  plexus.  Overcome  constipation  and 
in  many  cases  the  cure  is  effected.  Remove  the  pres- 
sure of  the  abdominal  viscera,  prevent  lacing,  cause 


184 

patient  to  stand  and  sit  with  spine  straight,  thorax  for- 
ward and  abdomen  drawn  backward.  Control  of  the 
lower  portion  of  the  abdominal  parieties  so  as  to  exert 
a  constant  lifting  force  on  the  abdominal  contents  will 
prevent  many  diseases  and  overcome  the  incipient 
stages  of  all. 

The  pudic  nerve  should  be  stimulated  as  it  passes 
over  the  spine  of  the  ischium.  This  nerve  supplies 
most  of  the  perineal  muscles.  By  maintaining  their 
tonic  condition  the  vaginal  walls  are  suported,  thus 
keeping  the  uterus  in  place.  Relaxation  of  the  perin- 
eum tends  toward  prolapsus. 

Good  effects  are  secured  by  drawing  upward  the  pelvic 
portion  of  the  abdominal  wall.  This  is  done  while  the 
patient  is  lying  on  her  back,  the  legs  flexed;  or  by  draw- 
ing the  viscera  forward,  the  patient  occupying  the 
genu-pectoral  position.  Ordinary  cases  of  displace- 
ments may  be  cured  by  the  preceding  movements.  A 
very  efficient  treatment  for  misplacement  is  to  insert 
two  fingers  into  the  vagina,  the  patient  in  the  genu- 
pectoral  position,  the  abdominal  viscera  pushed  for- 
ward, then  spread  the  fingers  so  as  to  admit  air  to  the 
vagina.  The  pressure  of  the  atmosphere  will  usually 
replace  the  uterus.  The  patient  should  remain  quiet 
for  some  time  after  the  treatment.  Stimulation  of  the 


185 

« 

round  ligament  is  useful  should  there  be  retro-flexion 
or  retro-version. 

Coccygodinea  should  be  treated  by  removing  any 
irritation  to  the  coccygeal  nerve  ;  and  by  quieting  the 
coccygeal  gland.  A  dislocated  coccyx  may  give  much 
trouble  of  this  nature. 

Metritis  is  treated  through  the  lumbar  nerves  and 
the  hypogastric  plexus.  The  pudic  nerve  is  always  to 
be  treated  in  cases  involving  the  vaginal  walls. 

Ovaritis  is  often  relieved  at  the  lower  dorsal  or  first 
lumbar  through  correction  of  osseous  dislocation. 
Dysmenorrhcea  can  be  relieved  and  cured  by  correc- 
tion of  these  lumbar  and  lower  dorsal  vertebra,  and 
the  sacro-iliac  synchondrosis,  together  with  the  cor- 
rection of  any  uterine  displacement.  Amenorrhoea  is 
relieved  by  building  up  the  respiratory,  circulatory 
and  alimentary  systems ;  by  spreading  the  lumbar 
vertebrae  with  a  "figure  of  eight "  motion  ;  and  in 
addition  by  striking  your  left  hand,  laid  across  the 
patient's  sacrum,  sharply  with  your  right  closed  fist. 
This  is  a  powerful  stimulant. 

The  foetus  is  formed  as  the  result  of  the  union  of  Development 

of  embryo. 

matured  male  and  female  reproductive  cells,  either 
within  the  uterus  or  the  Fallopian  tubes.  Segmenta- 
tion rapidly  takes  place,  forming  the  blastoderm.  A 
triple  layered  arrangement  of  cells  prevails  for  two 


186 

weeks,  at  which  time  the  stage  of  the  ovum  is  suc- 
ceeded by  the  stage  of  the  embryo,  lasting  until  the 
fifth  week.  The  remaining  weeks  of  pregnancy  are 
called  the  foetal  stage.  The  formation  of  the  neural 
folds  and  the  notochord  begins  at  the  end  of  the 
second  week.  Up  to  this  time  the  ovum  has  absorbed 
its  nourishment  from  the  lymph  of  the  uterine  mucous 
membrane.  Now  the  development  of  the  membrane 
begins.  First  the  amnion,  the  innermost  layer,  is 
formed  from  the  ectoderm  and  from  the  mesodermal 
layer  of  the  embryo.  Outside  of  the  true  amnion  the 
false  amnion  is  formed  by  the  reduplicature  and  fusion 
of  the  laminae  of  the  true  amnion.  The  allantois 
develops  from  the  hind  gut  and  serves  to  connect  the 
foetus  with  the  placenta. 

By  its  development  the  allantoic  tissue  unites  with 
the  outer  or  false  amnion,  serving  to  form  the  embry- 
onal portion  of  the  placenta,  uniting  with  the  uterine 
or  maternal  portion  which  is  developed  from  tissue  of 
the  mucous  membrane  of  the  uterus.  There  is  thus  a 

Origin  of 

double  origin  for  the  placenta.  The  sac  of  the  allan- 
tois with  its  amniotic  wrapping  is  the  forerunner  of 
the  umbilical  cord  which  connects  the  foetus  and  the 
mother  through  the  placenta.  The  placenta  receives 
blood  from  the  uterine  arteries  of  the  mother  which 
have  been  increasing  from  earliest  pregnancy.  It  is 


187 

drained  back  to  the  maternal  circulation  by  the  uterine 
veins.  The  umbilical  veins,  later  veins,  begin  in  the 
foetal  portion  of  the  placenta  and  absorb  through  their 
capillary  walls  the  pure  blood  brought  thither  by  the 
uterine  arteries ;  the  blood  thus  passes  to  the  foetus, 
entering  its  venous  circulation,  the  portal  vein  and  the 
inferior  vena  cava.  The  placenta  receives  impure 
blood  from  the  hypogastric  arteries,  constituent  parts 
of  the  umbilical  cord. 

Thus  the  nourishment  for  and  the  excrement  from 
the  foetus  must  be  carried  through  the  maternal 
vessels. 

The  foetus  during  the  first  three  months  is  largely 
head,  assuming  the  human  form  during  the  ninth  to 
the  eleventh  week.  At  five  months  the  heart,  liver 
and  head  are  alike  very  much  developed,  while  move- 
ments are  now  felt.  The  vernix  caseosa  is  formed  by 
the  sixth  month  and  is  completed  by  the  eighth. 

It  is  safe  to  assume  that  a  woman  apparently  well 
formed  will  come  safely  through  childbirth,  so  it  is  not 
necessary  to  examine  the  pelvis  unless  there  is  a 
deformity  or  a  rachitic  history.  But  there  are  certain 
precautions  which  every  woman  should  take  during 
pregnancy.  Diet,  of  fruits  and  cereals,  outdoor  exer- 
cise and  baths  are  conducive  to  an  easy  delivery  and  a 
perfect  child. 


188 

When  called  the  physician  should  carry  with  him  a 
cool  head  and  willing  hands.  In  addition  he  should 
have  a  case  containing  tablets  of  mercury  bichloride, 
shears,  surgeons'  cotton,  a  roll  of  clean  muslin,  a 
sponge  and  a  spool  of  silk  thread. 
Essential  Uncleanliness  and  untidiness  in  a  case  of  this  kind 

Preparations. 

is  a  crime.  The  expectant  mother  should  first  be  given 
a  sitz  bath  carefully  cleansing  the  perinseum.  Then 
the  hand  of  the  operator  after  a  thorough  scrubbing 
with  soap  and  water  should  be  held  in  a  bichloride 
solution,  i  to  i ,000,  for  a  few  minutes  and  then  an 
examination  of  the  patient  should  be  made.  The 
hand  should  be  thoroughly  cleansed  and  rendered 
aseptic  previous  to  each  examination.  This  must 
never  be  disregarded. 

The  bed  should  be  prepared  by  placing  either  oil- 
cloth, rubber  or  a  layer  of  newspapers  beneath  the 
sheet.  The  perinseum  and  vagina  should  be  thor- 
oughly relaxed.  Pressure  upon  and  manipulations  of 
the  perineal  body  will  produce  a  very  satisfactory 
result.  The  dilatation  of  the  os  may  be  very  much 
hastened  by  passing  the  finger,  thoroughly  aseptic, 
around  the  edge  of  the  os,  also  by  pressure  on  clitoris 
and  on  round  ligaments.  This  will  lessen  pain. 
To  reduce  the  pain  press  on  either  side  of  the  spine  in 
the  lumbar  region,  fourth  and  fifth,  and  in  the  eighth 


189 
to  tenth   dorsal  ;  this    does    not   retard   the  progress  Manipulations 

that  aid  in 

of  the  case.  Should  the  pains  and  the  expulsive 
movements  of  the  uterus  become  tardy,  stimulation  in 
the  lumbar  region  may  be  very  effective.  Relaxation 
of  the  round  ligaments  as  they  pass  over  the  pubic 
crest  will  allow  the  uterus  to  protrude  further  into  the 
canal  of  the  vagina.  Steady  pressure  at  the  sym- 
physis  pubis  will  also  aid  in  relaxation  of  the  parts  and 
reduction  of  pain. 

Should  the  child  be  large  and  the  labor  difficult  it  is 
well  to  guard  the  periuseum  by  holding  the  hand 
against  the  perineal  body,  thus  guiding  the  infant 
through  the  vaginal  opening.  Push  the  tissues  from 
the  symphsis  toward  the  perineal  body. 

As  soon  as  the  head  is  born  examine  to  see  if  the 
cord  be  around  the  neck.  If  so,  loosen  and  follow  it 
with  the  fingers,  one  on  either  side,  within  the  vagina 
to  protect  it  from  occlusion.  In  foot  presentation  the 
body  should  be  wrapped  in  cloth  or  cotton  to  pro- 
tect from  the  air  until  the  head  is  born.  The  cool  air 
against  the  skin  may  stimulate  the  respiratory  center, 
causing  the  child  to  breathe. 

As  soon  as  the  child  is  born,  open  its  mouth,  cleanse 
the  mucous  passages  until  it  has  given  a  good  cry, 
then  keep  it  covered  and  wait  until  the  pulsations  have 
ceased  in  the  unbilical  cord.  Now  draw  the  cord 


190 

between  the  thumb  and  finger  toward  the  unbilicus 
and  tie  with  a  clean  thread  about  two  and  one-half 
inches  from  the  infant's  navel,  tie  again  an  inch 
further  out  and  snip  the  cord  between  these  points. 
If  the  placenta  has  not  yet  been  delivered,  gentle 
traction  on  the  cord  may  produce  it.  The  mother  can 
usually  assist  by  an  expulsive  movement,  as  cough- 
ing or  blowing  into  the  closed  hand.  There  is 
no  need  to  hurry  in  this  matter,  an  hour  may  some- 
times elapse  before  the  placenta  is  passed.  In  case  it 
is  not  easily  secured  pressure  on  the  abdominal  wall 
above  the  pelvis  may  secure  it.  Place  the  palms  flat 

HOW  to  obtain    upon  the  walls  and  press  forcibly  downward.     Do  not 

the  placenta. 

insert  the  hand  into  the  uterus  unless  necessary.  If 
the  hand  is  inserted,  be  sure  that  it  is  aseptic.  Pass 
the  fingers  between  the  placenta  and  the  uterine  wall, 
the  air  entering  will  often  release  it.  If  this  is  not 
sufficient,  gently  force  it  from  the  wall  of  the  uterus. 
After  the  delivery,  if  there  has  been  no  laceration 
and  no  cause  to  suspect  infection,  the  external  genitals 
should  be  carefully  cleansed,  the  vulva  protected  by  a 
cloth  fastened  as  the  napkins  are  usually  fastened. 
Between  the  napkin  and  the  vulva  should  be  a  pad  of 
surgeon's  cotton.  Should  there  be  post-partum  hem- 
orrhage it  can  be  checked  by  stroking  sharply,  with 
cold  hand,  the  mons  veneris. 


191 

The  uterus  must  be  reduced  to  contract  the  vessels  Antiseptic 

injections 

and  close  the  sinuses.  This  is  done  by  gently  work- 
ing the  fundus  through  the  abdominal  wall.  This 
will  reduce  the  intensity  and  the  number  of  the  after- 
pains  and  shorten  the  lying-in  period  and  prevent 
hemorrhage. 

The  mother  should,  after  being  made  scrupulously 
clean,  be  left  to  sleep.  Rest  is  the  great  restorer.  The 
nurse  should  be  instructed  to  carefully  cleanse  the  ex- 
ternal genitals  with  soap  and  water,  following  with  a 
solution  of  bichloride  of  mercury,  i  to  2,000.  Should 
it  be  deemed  necessary  to  use  an  injection  a  perfectly 
sterile  pipe  must  be  used,  having  been  dipped  in  boil- 
ing water,  both  tube  and  pipe  having  been  left  in  a 
bichloride  solution  of  i  to  1,000  for  ten  minutes.  The 
injection  may  be  i  to  4000  bichloride  or  creolin  i  to  100 

(i%). 

The  nurse  should  be  given  explicit  directions  as  to  core  of  the 

breasts. 

the  care  of  the  patient,  The  breasts  should  be  watched 
carefully.  A  scanty  secretion  of  milk  may  be  in- 
creased by  a  separation  of  the  upper  five  or  six  ribs, 
lifting  scapula,  and  freeing  the  subclavian  and  axillary 
arteries.  This  affects  the  internal  mammary  branches 
which  supply  the  mammary  gland.  It  also  stimu- 
lates the  intercostal  nerves  in  this  region.  We  spread 
the  ribs  increasing  the  blood  supply  through  the 


192 

perforating  arteries,  and  giving  a  perfect  drainage 
through  the  veins.  The  internal  mammary  artery  may 
be  reached  at  its  origin  from  the  subclavian,  producing 
effect  through  the  plexus  derived  from  the  subclavian 
and  from  the  inferior  cervical  ganglion.  L,et  me  repeat 
that  the  introduction  of  the  hand  into  the  uterus  to 
take  the  placenta  is  the  most  dangerous  part  of  child- 
birth. It  should  be  done  only  as  a  last  resort. 


CHAPTER  XL 


CONSTIPATION,  RHEUMATISM  AND  CATARRH. 

/^VCCUPATION,  diet,  the  drug  habit,  irregularity 
^•^  in  the  time  of  defecation,  morbid  secretions  of 
liver  and  pancreas,  osseous  lesions  and  general  neurotic 
conditions,  are  causes  of  constipation,  while  this  may 
in  turn  be  the  cause  of  anaemia,  neuritis,  menstrual 
disorders,  poor  circulation,  piles,  haemorrhoids,  etc. 
The  normal  time  for  evacuation  is  once  per  day  though 
it  may  vary  from  this,  twice  a  day  being  perfectly 
natural  with  some  and  once  every  second  day  being 
in  many  cases  normal. 

The  condition  is  massing  of  fecal  material  in  the 
lower  bowel, — usually  the  descending  colon  and  the  sig- 
moid.  A  preceding  atony  of  the  colon,  particularly  the 
musculature  of  the  sigmoid,  is  frequently  an  obstinate 
cause.  That  constipation  so  frequently  follows  peri- 
tonitis and  fevers  is  a  suggestion  of  a  very  common 
cause,  viz. :  inflammation  with  its  consequent  engorge- 
ment and  stasis. 


194 

The  presence  of  fecal  matter  within  the  intestine 
should  lead  to  a  normal  peristalsis,  —  when  the  nerves 
are  no  longer  stimulated  by  such  a  condition,  or  when 
the  muscles  fail  to  respond  to  such  stimulation,  then 
costiveness  results.  If  normal  peristalsis  occurs  above 
while  there  is  sluggishness  in  the  lower  portion  of  the 
tract,  then  impaction  must  occur.  This  impaction 
may  occur  at  the  hepatic  or  splenic  flexures,  or  in  the 
left  inguinal  region,  extending  down  into  the  sigmoid 
and  the  rectum.  In  case  of  such  impaction  the 
masses  must  be  broken  up  and  removed  before  the 
treatment  directed  toward  restoring  tonus  to  the  mus- 
culature and  health  to  the  mucosa  can  be  effective. 

The  blood  supply  is  from  the  superior  and  inferior 
mesenteric  arteries  to  the  colon  and  sigmoid,  while  the 
rectum  receives  its  supply  from  the  inferior  mesenteric, 
the  internal  pudic,  the  sacra  media,  the  sciatic,  and, 
in  the  female,  the  vaginal. 

The  innervation  of  the  lower  bowel  is  from  the 
vagus,  lumbar  and  sacral, — the  vagus  supply- 
ing the  alimentary  tract  as  far  as  the  sigmoid 
while  the  lumbar  and  sacral  are  inhibitor  and  aug- 
mentor  respectively  to  the  remainder.  The  lumbar 
are,  in  addition,  vaso-constrictors  through  their  rami 
communicantes,  while  their  secretory  fibres  must  con- 
trol the  flow  of  the  intestinal  juices.  The  sacral 


195 

nerves  distributed  directly  to  the  pelvic  organs  are  the 
vaso-  dilator  and  also  viscero-motor  to  the  large  intes- 
tine. The  lower  portion  of  the  rectum  receives  fibres 
from  the  inferior  hsemorrhoidal,  a  branch  of  the  pudic. 

In  treatment  of  this  condition  the  patient  must  yield 
strict  obedience  to  directions.  Few  things  are  better 
than  outdoor  exercise. 

The  normal  number  of  nerve  impulses  should  be 
sent  along  the  nerves  of  the  abdominal  muscles,  the 
muscles  of  the  thigh  and  the  hip  in  order  that  the 
proper  amount  of  impulses  reach  the  lower  portion  of 
the  intestinal  tract,  which  is  innervated  by  nerves 
originating  in  the  corresponding  segments  of  the 
cerebro-spinal  axis.  Physiological  nerve  impulses 
passing  along  the  lumbar  and  sacral  nerve  trunks, 
both  afferent  and  efferent,  cannot  but  favorably  affect 
the  splanchnic  fibres  from  the  same  nerves  distributed 
to  the  viscera  within  the  abdominal  and  pelvic  cavities. 
Any  form  of  physical  exercise  involving  the  use  of 
the  muscles  of  the  abdomen  and  thigh  will  thus  be 
beneficial  to  this  particular  condition. 

See  that  your  patient  uses  water  freely  ;  few  people 
drink  enough.  The  lower  bowel  is  the  great  dessi- 

Watenf 

cator ;  but,  should  the  fecal  mass  contain  but  little  value' 
fluid  this  will  all  be  taken,  and  a  dry  and  hard  resist- 
ant mass  will  remain  to  irritate  the  intestinal  mucosa 


196 

until  finally  it  fails  to  respond  to  such  irritation. 
Then  sets  in  an  atonic  condition  of  the  bowel,  due  to 
its  over-distention  by  the  continual  crowding  down 
from  above  the  material  left  from  each  meal.  Three 
pints  of  water  per  day  is  necessary,  and  more  than 
this  amount  if  much  is  taken  from  the  system  by  per- 
spiration. This  water  is  a  stimulus  to  the  circulation 
and  to  the  liver,  and  an  incalculable  benefit  to  the 
kidneys. 

The  osteopathic  treatment  for  constipation  is  based 
upon  the  anatomy  and  physiology  of  the  bowel  and 
its  contributory  glands.  The  liver,  by  its  contribution 
of  bile,  is  one  of  the  most  important  organs  in  the 
work  of  the  bowel.  Its  bile  is  beyond  doubt  the 
normal  stimulus  to  peristalsis.  Thorough  change  of 
blood  within  the  substance  will  overcome  the  stasis  of 
blood  and  reduce  the  resistance  "afronte,"  thus 
facilitating  the  drainage  from  the  entire  alimentary 
canal  from  stomach  to  rectum.  This  reduction  of 
stasis  will  of  itself  overcome  plethora  of  venous  blood 
within  the  mesentery,  meso-colon,  meso-sigmoid  and 
meso-rectum. 

Venosity  of  blood  is  itself  a  cause  of  excessive  peri- 
stalsis, should  the  venosity  be  introduced  suddenly, 
but  when  it  comes  gradually  as  the  result  of  a 
decreasing  activity  of  the  liver  then  it  leads  to  atony 


197 

of  the  walls,  sluggishness,  impaction  and  the  various 
attendant  conditions  of  constipation.  Hence  to  relieve 

Treatment. 

constipation,  stimulate  the  liver  to  activity  by  treating 
directly  over  the  walls  of  the  abdomen  and  thorax 
beneath  which  it  lies.  A  stimulation  along  the  line 
of  the  hepatic  artery,  pressure  against  the  gall  cyst,  the 
patient  making  the  greatest  expiratory  effort  with  the 
thighs  flexed  upon  the  abdomen,  will  be  effective.  Sep- 
aration of  the  ribs  by  the  aid  of  the  serratus  magnus 
and  latissimus  dorsi,  and  correction  of  any  osseous 
lesion  that  may  exist  near  the  ninth  or  tenth  dorsal 
will  restore  the  liver  to  normal  function. 

In  addition  to  this  treatment  of  the  liver  the  bowel 
must  have  especial  attention.  The  major  portion  of 
the  large  intestine  and  all  of  the  small  intestine  receive 
their  secretory,  trophic,  vaso-motor,  motor  and  inhib- 
itory nerves  via  the  solar  plexus.  Through  their  end- 
ings these  fibres  may  be  reached  at  any  part  of  the 
abdominal  parieties  anteriorly  or  in  the  splanchnic 
region  of  the  spine. 

The  colon,  sigmoid  and  rectum  must  first  be 
cleansed  from  any  impacted  feces.  The  colon  should 
be  carefully  kneaded.  By  such  action  the  end  fibres 
of  the  pneumogastric  nerve  may  be  stimulated,  thus 
increasing  peristalsis.  The  secretory  fibres  in  the 


198 

plexus  of  Meissner  are  also  stimulated,  thus  tending 
to  restore  the  normal  condition. 

The  lumbar  region  will  usually  show  lesions  in  con- 
stipation. These  may  be  osseous,  and  if  such  will  be 
corrected,  each  case  demanding  its  own  treatment.  In 
case  of  muscular  contracture  which  has  cut  off  the 
nerve  force  to  the  part,  then  such  contracture  must  be 
reduced.  This  will  usually  be  found  to  be  in  the 
region  of  the  quadratus  lumborum.  This  muscle  may 
be  stretched  by  a  bias  stretch,  placing  one  hand  on  the 
iliac  crest,  the  other  on  the  lower  ribs  at  or  near  their 
angles,  the  patient  lying  on  his  side  with  face  toward 
the  operator.  Drawing  the  ribs  toward  him  and  the 
ilium  from  him,  and  then  reversing  the  movement  the 
operator  is  enabled  to  accomplish  a  thorough  reduction 
of  this  muscle.  The  psoas  muscles  lying  in  contact 
with  the  ascending  and  descending  colon  and  also 
containing,  as  it  were,  the  origin  of  the  lumbar  plexus, 
is  an  important  factor  in  osteopathic  manipulation  for 
constipation.  It  is  attached  to  the  lumbar  and  to  the 
last  dorsal  vertebrae,  and  is  inserted  into  the  lesser 
trochanter.  Flexion,  rotation  and  circumduction  of 
the  thigh  will  affect  this  muscle  which  will  in  turn  in- 
fluence the  lumbar  plexus.  Good  results  are  obtained 
by  placing  patient  on  face  and  strongly  raising 
the  legs. 


199 

The  sacral  nerves  are  the  motor  nerves  to  the 
descending  colon,  the  sigmoid  and  the  rectum,  and 
their  stimulation  will  increase  the  movement  of  that 
portion  of  the  canal. 

There   is   often   soreness    in   this  region,    showing 

'    nerve. 

need  of  stimulation  to  these  nerves.  The  pudic 
nerve  which  sends  its  inferior  hsemorrhoidal  branch  to 
the  rectum  may  be  reached  at  the  ischio-rectal  fossa. 
This  nerve  should  not  be  overlooked  in  constipation  as 
it  often  has  an  important  effect  on  this  condition  when 
due  to  rectal  enervation. 

The  sphincters  should  also  be  carefully  examined  as 
it  may  be  that  they  are  so  contracted  as  to  prevent  the 
passage  of  the  feces.  The  finger  well  covered  with 
vaseline  is  a  good  dilator.  After  the  insertion  of  one, 
two  should  be  inserted  and  then  forceful  separation 
serves  to  overcome  the  contraction  of  the  sphincter. 
The  finger  should  carefully  examine  the  rectal  walls 
for  prolapsus,  growths  or  haemorrhoids. 

The  coccyx  should  be  examined,  as  it  is  often 
thrown  forward,  acting  as  a  physical  impediment.  It 
can  be  replaced  by  passing  the  finger  above  and  in 
front  of  it  and  drawing  downward,  thus  extending  it 
upon  the  sacrum.  The  ganglion  impar,  situated  on 
the  anterior  surface  of  the  coccyx,  is  easily  reached 
per  rectum  and  its  stimulation  serves  to  increase  the 


200 

activity  of  the  sympathetic  nerves  regulating  the  cir- 
culation and  the  alimentary  systems. 

The  sigmoid  is  often  more  or  less  prolapsed  in  case 
of  constipation.  This  can  be  raised  by  traction  in  the 
iliac  region  through  the  abdominal  wall,  the  patient 
lying  on  side,  the  operator  standing  behind,  the  legs 
being  slightly  flexed  in  order  to  loosen  the  abdominal 
wall.  Should  the  vertebrae  be  posterior  the  patient 
may  lie  on  side  and  the  operator  first  exaggerate  the 
condition  by  curving  the  lumbar  spine,  then  pressing 
upon  the  prominent  spines  while  returning  the  spine 
to  the  normal  condition.  The  patient  may  lie  face 
downward,  after  thorough  and  complete  relaxation, 
and  the  operator  put  sudden  pressure  upon  the  spines. 
This  is  very  effective,  though  care  must  be  used  to 
avoid  violence. 

The  patient  seated  on  a  stool  is  in  a  position  of 
advantage.  Sometimes  it  is  helpful  to  have  the 
patient  lie  obliquely  across  the  table  and  then  put  an 
auger  twist  upon  his  legs.  In  addition  to  these  treat- 
ments the  quadratus  lumborum  must  be  relaxed  and 
the  thighs  flexed  and  rotated  outward  so  as  to  call 
into  activity  the  psoas  muscle.  Separation  of  the 
knees  against  the  muscular  resistance  of  the  patient  is 
of  value. 


201 
RHEUMATISM. 

The  term  rheumatism  does  not  carry  with  it  any  symptoms. 
definite  idea  of  either  cause  or  symptoms.  Manifest- 
ing itself  by  pain,  with  or  without  swelling,  it  inter- 
feres with  the  use  of  the  muscles,  enlarges  the  bones 
at  their  articular  portions,  and  by  stasis  of  blood 
stiffens  the  ligaments,  tendons  and  connective  tissue 
until  from  proliferations  and  shortening  of  the  fibres 
motion  is  more  or  less  completely  lost.  This  may 
affect  one  articulation  or  may  involve  the  entire  body. 
The  presence  of  lactic  acid  or  its  isomeric  form  in  the 
blood  in  this  disease  has  led  to  the  belief  that  it  is  one 
of  the  primary  causes  of  the  disease.  Though  often 
present  it  does  not  follow  that  lactic  acid  is  a  cause  of 
the  disease,  but  would  rather  suggest  it  as  a  result. 
The  fact  that  the  disease  may  confine  itself  to  one  or 
to  a  few  articulations  would  indicate  that  there  are 
other  factors  involved.  Our  system  of  therapy 
teaches  that  every  organ  or  member  will  function 
properly  if  its  structure  be  perfect  and  the  natural 
nerve  impulses  be  unchanged. 

That  a  single  tissue  or  organ  may  be  the  seat 
of  rheumatic  affection  points  unmistakably  to  a  weak- 
ened power  of  resistance  on  the  part  of  that  tissue  or 
organ,  or  else  to  what  is  the  same  thing,  deficiency  in 
nourishment  or  to  a  failure  in  impulses  reaching  it 


202 

from  the  nervous  system.  That  there  are  disturbing 
elements  in  the  blood  cannot  be  doubted.  That  they 
are  the  result  of  failure  of  the  assimilative  tissues, 
increased  by  a  disturbance  of  the  harmony  existing 
between  katabolism  and  excretion,  seems  certain. 
This,  then,  will  attribute  the  trouble  to  the  liver  on 
one  hand  and  to  the  kidneys  on  the  other.  The  respir- 
atory power  may  be  at  fault,  leading  to  retarded 
oxidation  and  to  the  formation  of  suboxides.  The 
change  in  the  functioning  of  the  liver  interferes  with 
the  character  of  the  blood,  thus  involving  the  heart 
and  interfering  with  the  circulation. 

Our  treatment  is  directed  to  the  nervous  system  to 
re-establish  the  proper  control  of  the  disturbed  organs. 

In  all  cases  the  diet  must  be  carefully  selected ; 
cereals,  little  meat  and  a  reduction  of  the  carbo- 
hydrates will  aid  in  overcoming  the  acidity  of  the 
blood  and  in  resting  a  disturbed  digestive  tract. 

As  an  adjunct  to  other  treatment  the  patient  should 
be  required  to  drink  freely  of  hot  water.  This  serves 
to  flush  the  sewers  of  the  body,  thoroughly  cleansing 
the  capillaries  and  washing  the  detritus  from  the  tub- 
ules of  the  kidneys. 

In  case  of  muscular  rheumatism  affecting  one 
muscle  or  a  group  of  muscles,  look  for  a  lesion  at 
the  exit  of  the  nerve  which  supplies  that  region. 


203 

Pressure  upon  the  nerve,  either  at  its  emergence  or 
along  its  course  may  be  the  cause  of  the  condition. 
This  frequently  disappears  after  a  single  treatment. 
Remove  the  cause  and  torticollis,  lumbago  and  similar 
forms  disappear. 

The  mono-articular  type,  whether  chronic  or  acute, 
is  in  most  cases  a  result  of  a  local  injury.  Correction 
of  this  lesion  will  be  followed  by  cure. 

In  cases  affecting  the  lower  limbs  the  three  points 
to  be  noticed  most  carefully  are  the  tissues  around  the 
exit  of  the  sciatic  nerve,  the  saphenous  opening  and 
the  lumbar  spine.  In  case  the  upper  limb  is  affected 
the  points  to  be  most  carefully  scrutinized  are  the 
cervical  vertebrae  from  the  fifth  to  the  eighth,  the 
interscapular  area  and  from  the  second  to  the  sixth 
dorsal  and  the  brachial  plexus. 

In  all  cases  the  spine  must  be  corrected,  stretched 
and  relaxed.  All  lesions  in  the  region  of  the  liver, 
seventh  to  tenth  dorsal,  must  be  corrected.  These 
may  be  lesions  of  bone  or  of  muscle. 

The  kidney  region,  eleventh  dorsal  to  first  lumbar, 
must  have  the  same  care  in  order  that  the  excretion 
may  be  thoroughly  accomplished  The  entire  splanch- 
nic area  must  be  stimulated  to  activity.  The  various 
nerves  affected  must  be  freed  from  pressure  their  entire 
length  so  as  to  overcome  stasis  in  their  blood  supply. 


204 

In  case  the  hands  and  feet  are  affected  treatment 
must  be  given  each  articulation  to  maintain  and  secure 
mobility.  While  the  nerves  are  hypersensitive,  caus- 
ing a  chronic  shortening  of  the  flexor  muscles,  it  is  of 
value  to  thoroughly  knead  the  muscles  to  secure  their 
relaxation.  Stretching  the  muscles  will  prevent  such 
contracture  or  will  correct  it  if  present.  In  case  of 
oedema  the  effusion  can  be  removed  by  pressure  and 
movement  directed  toward  the  venous  flow.  Acute 
attacks  should  be  treated  two  or  three  times  each  day. 
Hot  baths  are  valuable  adjuncts  to  the  treatments, 
though  care  must  be  used  to  avoid  taking  cold. 

CATARRH. 

In  considering  the  various  forms  which  this  disease 
may  assume  it  is  well  to  consider  the  primary  changes 
in  the  mucous  membrane  with  which  it  is  associated. 
There  is  always  an  initial  dilatation  of  the  blood  ves- 
sels due  to  an  inhibition  of  the  local  vaso-constrictor 
action.  This  results  in  an  increase  of  capillary  pres- 
sure, venous  stasis,  transudation  of  lymph,  oedema  and 
discharge.  This  discharge  at  first  is  thin  and  watery 
but  soon  changes  to  greater  consistency. 

It  may  be  acute  (coryza),  chronic  (rhinitis),  seasonal 
(hay  fever).  This  catarrhal  condition  may  affect  the 
mucous  tract  anywhere.  Our  treatment  for  it  is  as 


205 

follows  :  Secure  a  thorough  drainage  of  the  catarrhal 
tract  by  removing  any  stoppage  to  the  veins  from  the 
part.  Begin  this  by  thorough  relaxation  of  the  fol- 
lowing muscles  of  the  neck  :  the  platysma,  sterno- 
cleido-mastoid  and  the  more  deeply  lying  infrahyoid 
group,  the  scaleni,  the  recti  capiti  and  the  longus  colli. 
This  treatment  should  flow  be  followed  by  a  thorough 
relaxation  of  the  muscles  in  the  upper  dorsal  region 
including  the  muscles  connecting  trunk,  neck  and 
occiput. 

A  thorough  stimulation  of   the   superior  cervical  Treatment  of 

catarrh. 

ganglion  will  reduce  the  venous  stasis  while  a  stimu- 
lation of  the  cardiac  center  in  the  upper  dorsal  region 
will  result  in  sending  blood  from  the  mesenteric  reser- 
voir of  capillaries  to  the  cutaneous  surfaces,  relieving 
the  mucous  congestion,  equalizing  the  general  pressure 
and  at  the  same  time  furnishing  the  congested  mem- 
brane with  a  fresh  supply  of  pure  blood. 

The  nutritive  fibres  to  the  muscles  of  the  face  are 
transmitted  by  the  seventh  nerve.  This  may  be 
treated  by  relaxing  the  tissues  around  its  exit  as  it 
traverses  the  space  between  the  stylo-mastoid  foramen 
and  the  ramus  of  the  inferior  maxilla. 

The  sensory  and  trophic  distribution  to  skin  of 
the  face  and  mucous  membrane  of  catarrhal  tract 
is  through  the  fifth,  ninth  and  tenth  nerves.  These 


206 

nerves  are  treated  as  follows :  Pressure  on  the 
fifth  nerve  at  its  points  of  emergence  on  the  face  will 
quiet  the  sensory  nerves  and  bring  blood  to  the  sur- 
face. Downward  pressure  over  the  carotid  sheath  will 
reach  the  tenth  nerve  and  at  the  same  time  assist  in 
drainage.  The  ninth  nerve  is  reached  as  it  leaves  the 
jugular  foramen,  also  on  the  tonsils  internally,  in  case 
it  affects  the  Eustachian  tube  or  the  middle  ear. 

The  first,  second  and  third  cervical  are  often  at  fault 
in  this  trouble. 


CHAPTER   XII. 


HOW  AND  WHERE. 
( A  few  practical  bints  for  emergencies. ) 

IN  case  of  eye  trouble,  inflammation,  pain,  «tc.,  not 
due  to  the  presence  of  a  foreign  body,  treat  the  fifth 
nerve  at  its  terminal  portions  around  the  orbit ;  the 
superior  cervical  ganglion,  which  through  the  carotid 
and  cavernous  plexuses  is  distributed  to  the  eye  and  to 
the  parts  surrounding  it ;  the  first  and  second  cervical 
vertebra  ;  the  upper  dorsal,  the  latter  being  the  exit  of 
the  fibres  going  to  the  eye.  Pressure  on  eye  for 
muscles  of  orbit  and  for  ciliary  ganglion  on  fifth  nerve. 
Ear  :  The  ninth  nerve  for  the  ramus  tympanicus  ; 
the  auricular  branch  of  the  tenth  ;  the  auriculo-tem- 
poral  from  the  inferior  maxillary  of  fifth ;  the  small 
occipital  and  the  great  occipital ;  the  ninth  for  deaf- 
ness and  ringing  in  the  ear;  the  cervical  and  the  auric- 
ulo-temporal  for  earache.  Relax  the  opening  of  the 


208 

Eustachian   tube   in   pharynx  ;    the    second    cervical 
vertebra  is  often  a  disturbing  factor. 

Thyroid  Gland  :  Over  gland  itself,  following  veins, 
at  middle  and  inferior  cervical  ganglia,  raise  the  clav- 
icle ;  correct  first  rib.  Fifth  and  sixth  cervical  ver- 
tebra. 

Bronchial  Tubes  :  The  upper  three  ribs  ;  relax  the 
intercostal  muscles ;  relax  the  muscles  in  the  corre- 
sponding spinal  segment ;  raise  the  ribs. 

Lungs  :  Treatment  much  the  same  as  for  bronchial 
tubes,  extending  lower  to  ninth. 

Heart :  Quiet  it  by  steady  pressure  at  annulus  of 
Vieussens.  Raise  fifth  rib  ;  separate  ribs  on  left  side  ; 
hold  vaso-motors;  correct  lesion  in  upper  dorsal  region; 
inhibit  solar  plexus  to  equalize  circulation. 

Larynx  :     Tenth  nerve  ;  superior  cervical  ganglion . 

Tonsils :  Treat  by  stimulating  superior  cervical 
ganglion  ;  by  working  over  their  mucous  covering  ; 
by  treatment  at  exit  of  ninth  and  tenth  nerves. 

Headache  :  Work  downward  over  carotid  sheath  to 
aid  in  drainage ;  to  check  blood  supply  bend  back  head, 
pressing  tightly  against  vertebral  artery  ;  steady  pres- 
sure on  great,  small  and  suboccipital  nerves  at  basi- 
occiput ;  steady  pressure  on  filaments  of  fifth  nerve  ; 
look  for  uterine  or  ovarian  trouble ;  stomach  fre- 


209 

quently  at  fault ;   press  on  solar  plexus.      In  anaemic 
headache  stimulate  heart  action. 

Liver  :  Relax  at  ninth  and  tenth;  vibrate  the  liver; 
treat  over  solar  plexus ;  reach  gall  cyst  under  ninth 
costal  cartilages  on  right  side  ;  knead  liver. 

Stomach  :  Pressure  at  third  and  fourth  dorsal  on 
right  side  ;  osseous  lesions,  third  to  fifth  ;  quiet  vom- 
iting, pressure  at  angle  of  third  to  fifth  ribs  on  right ; 
elevate  the  ribs. 

Small  intestine  :  Reach  mesentery  through  meso- 
gastric  zone  ;  solar  plexus  back  of  stomach  ;  in  middle 
and  lower  dorsal. 

Large  intestine :  Flux  and  diarrhoea ;  patient  on 
face  ;  strong  pressure  on  each  side  of  spines  in  lumbar 
region  ;  lift  legs  while  pressing,  springing  spine  for- 
ward. 

Knuresis  :  Look  for  trouble  in  middle  lumbar ; 
sometimes  lower ;  examine  clitoris  in  female,  glans  in 
male  for  irritation  ;  examine  urine  for  cystitis  ;  correct 
spinal  lesion  ;  examine  for  phimosis,  vulvitis,  worms. 

Croup :  Loosen  the  tissues  of  the  neck,  giving 
especial  attention  to  the  deep  muscles  ;  work  on  supe- 
rior cervical  ganglion ;  follow  veins  and  lymphatics 
for  drainage.  Stimulate  in  dorsal  region. 

Sciatica  :  Lesion  is  usually  in  lower  lumbar  ;  often 
a  contraction  of  pyriformis  causes  it ;  stretch  this  and 


210 

other  external  rotators  by  turning  thigh  inward,  press- 
ing on  structures  closing  the  greater  sacro-sciatic 
notch  ;  follow  nerve  to  knee,  relaxing  the  structures  ; 
flex  leg  on  thigh  and  thigh  on  pelvis,  then  with  thigh 
flexed  extend  the  leg.  This  will  effectually  stretch 
the  sciatic  nerve. 

Toothache :  Press  on  branches  of  the  fifth  nerve, 
either  at  infraorbital  or  just  below  malar  bone,  over 
spheno -palatine  ganglion  beneath  the  zygoma,  and 
near  the  articulation  of  inferior  maxillary. 

Fainting :  I^eave  head  low ;  stimulate  heart  to 
action  through  the  inferior  and  middle  cervical  gan- 
glion. In  case  of  prolonged  unconsciousness  the 
fingers  inserted  into  the  rectum,  briskly  stimulating 
the  ganglion  impar,  will  usually  be  effective.  Stim- 
ulate the  suboccipital  region. 

Anterior  upper  dorsal :  Cross  patient's  arms  in 
front,  stand  behind.  Pull  on  wrists  and  push  outward 
and  forward  on  scapulae.  An  assistant  is  necessary 
for  this  work. 

Epistaxis  :  To  stop  bleeding  stimulate  superior  cer- 
vical ganglion.  Press  on  nose  at  inner  canthus  of  eye. 

Rigors  :  Strong  stimulation  in  dorsal  region.  Stim- 
ulation of  inferior  cervical  ganglion.  Strongly  stimu- 
late liver.  Stimulate  solar  plexus.  Increase  respira- 
tory activity.  I^oosen  contractures  in  cervical  region. 


211 

Epileptic  convulsions  :  Hold  strongly  on  suboccip- 
ital  region,  pressing  head  backward.  Relax  the 
muscles  in  upper  dorsal. 

Cramps  and  clonic  spasms  in  women  attributable  to 
uterine  irritation  :  Inhibition  in  lumbar  region  and  the 
round  ligaments  ;  sometimes  replace  uterus. 

Hiccoughs  :  Inhibition  of  the  phrenic  over  the 
third,  fourth  and  fifth  cervical.  If  severe,  treat 
splanchnic  area. 

Tormina  :     Inhibit  lumbar  nerves  and  solax  plexus. 

Tenesmus  :     Inhibit  over  sacrum. 

Depressed  rib  :  Use  arm  as  lever  and  while  pulling 
upward  and  backward  with  one  hand,  press  strongly 
at  angle  of  ribs  with  other,  maintaining  the  pressure 
until  the  arm  is  returned  to  a  position  of  rest. 

Patient  may  lie  on  side  or  back,  or  may  sit  for  this 
treatment.  The  knee  may  be  placed  against  the 
vertebra,  operator  then  using  both  hands. 

First  or  second  rib  elevated  :  Place  thumb  of  one 
hand  on  head  of  rib.  Draw  hand  in  opposite  direction 
so  as  to  tighten  scaleni  muscles,  then  pressing  down- 
ward on  rib  rotate  the  hand  and  draw  back  toward 
affected  rib.  This  will  slip  rib  into  position. 

Eleventh  and  twelfth  rib  elevated  :  Stretch  quadra- 
tus  lumborum  and  push  downward  on  angle  of 
depressed  rib. 


GENERAL  INDEX. 


ABDOMEN    147 

ALLOCHIRIA 49 

AMENORRHCEA. 185 

ANKLE 177 

Tendons  of 178 

Drainage  of 178 

ANTISEPSIS 32 

AORTA,  bifurcation  of 148 

ARM,  vaso-motors  of 94,  103 

Vaso-constrictors  of 76 

A  lever 127 

ARTERIES,  coronary 80 

Carotid 122 

Internal  mammary 192 

Subclavian 122 

Anterior  tibial 177 

Posterior  tibial 177 

Femoral 175 

Of  intestine 194 

ARTICULATION,  lumbo-sacral 161 

Claviculo-acromial 169 

ASEPSIS 32 

A  safe  guard 40 

Method  of  securing 191 

ATLAS 98,  115 

AUGMENTORS,  cardiac 65,  73,  99 

Axis 98-116 


B 

BACILLUS 33 

BACTERIA,  Classified 33 

Defined 33 

Where  found 34 

Size  of 34 

Developement  of 34 

Products  of 35 

BLADDER,  sensory  nerves  to. .  .96,  104 

BLASTODERM 185 

BLOOD,  a  germicide 32 

BRAIN,  vaso-motors  for 93 

BREASTS,  care  of 191 

Treatment  of 191 

BRONCHIAL  TUBES 208 

Treatment  of 146,  208 


CECUM  158 

CANAL,  inguinal 148 

CATARRH 204 

Symptoms  of 205-206 

Lesions  for 206 

CAUSES  OF  DISEASE 21 

CELL,  a  unit  41 

Function  of 41 

Conditions  of  development ,  41 


214 


CENTER,  defined 56 

Osteopathic 56 

For  coughing 56 

Eye,  ear,  face 98 

For  hiccoughs 98,  211 

Lungs,  arm,  heart 99,  103 

Stomach 100,  103 

Liver 100,  103 

Spleen 100,  103 

Chills zoo 

Uterus,  ovary 100 

Diarrhoea 100 

Biadder 101 

For  vagina 101 

For  spinchter  ani 101,  104 

For  pharynx 102 

For  duodenum 103 

Vaso-motor 85 

Osteopathic 98  to  104 

Thermogenic 92 

How  treated 57 

CHEST,  examination  of 136 

Asymmetry  of 137 

Enlargement  of 138 

Lines  of 143 

CLAVICLE 164,  166 

Depressed 128 

Cocci 33 

COCCYX 162 

In  constipation 199 

COCCYGODYNIA 185 

CONTRACTION 59 

CONTRACTURE 112 

COLLATERALS 64 

CONSTIPATION,  causes  of.     193 

Treatment  of 196 

Lesions  for 198 

CONVULSIONS 211 

CORD,  umbilical 189 

Umbilical,  cutting  of 190 

CRAMPS 211 


CROUP,  treatment  of 209 

CURVES,  spinal 114 


DIARRHOEA 100,  209 

DIET 18 

DISEASE,  defined 19 

Causes  of 20 

Transmission  of 23 

DISINFECTION 40 

DISLOCATION,  femoral 148 

DUODENUM 157 

DYSMENORRHCEA 185 

E 

EAR,  treatment  of 207 

Nerves  of 207 

ELBOW,  landmarks  of 170 

Dislocation  of. 171 

ENURESIS 209 

EPISTAXIS 210 

EUSTACHIAN  TUBE 121 

EXAMINATION,  position  for..  117,  118 

Vaginal 182,  183 

EYE,  lesions  for 68 

Treatment  of 207 


FAINTING 210 

FALLOPIAN  TUBES 181,  182,  185 

FASCIA 48 

FEMORAL  RING 148-173 

FEMUR,  head  of 173 

Condyles  of 176 

FLUX 209 

FCETUS,  development  of 185,  186 

G 

GALL  BLADDER 152 

Treatment  of .   153 

GANGLION,  Meckel's 120 


215 


Impar 62 

Superior  cervical 67 

Middle  cervical 70 

Middle  cervical,  function  of.  .70,  71 

Middle  cervical,  fibres  from 71 

Inferior  cervical 71 

Superior  cervical 87 

GENITALIA 94,  104 

GERMS 32 

Pathogenic 35 

How  enter  tissue 39 

Diseases  36 

Diseases,  how  treated 37 

GLAND,  thyroid 93,  99,  103,  125 

Thyroid,  vessels  of 125 

Thyroid,  nerves  of 125 

Thyroid,  treatment  of 125 

GYNECOLOGY 179 


HART,  DR.,  theory  of 109 

HEALTH 15 

How  maintained 42 

HEAD'S  law  49,  in 

Diagnosis  by 50 

HEART 94,  96 

Treatment  of 80,  140,  141,  208 

Position  of. 129 

Boundaries  of 139 

Trouble,  lesions  for 142 

Centers  for 96,  103 

HEADACHE 208 

HEREDITY 23 

HICCOUGHS 98,  211 

HILTON'S  law 48 

HIP 173 

Dislocation  of 174 

HYOID  bone 121 

HYPER^MIA 26,  179 

HYPER^ESTHESIA.  ,  .26 


IMMUNITY,  by  heredity 23 

Defined 38 

Examples  of 38 

IMPULSES,  nervous 25 

IMPACTION    194 

IMPAR,  ganglion  of 199 

INHIBITION,  effect  of 50 

Defined 53 

By  reflex    108 

INSPECTION 137 

INTESTINE 94,  103,  209 

K 

KIDNEY 94,99,159 

Sensory  nerve  to 96 

Treatment  of 159 

KNEE 175 

Ligaments  of 176 

Structures  around 176-177 


LARYNX 121,  208 

LEG 94 

LESIONS,  structural 21 

Defined 24 

Kind  of    24 

Effect  of 24 

Osseous 25,  26 

Muscular 26,  43 

Correction  of 27 

LEUCOMAIN 35 

LEUCORRHCEA 180 

LIGAMENT,  Poupart's 149,  173 

LlGAMENTUM  NUCH^E 112 

LINEA  ALBA 147 

LINE,  Nelaton's 174 

LIVER 94,  96,  103,  209 

Treatment  of 130,  149,  153 

Displacement  of 150 

Percussion 150 


216 


Function  of 150 

Nerves  of 151 

Center  for  152 

LUNGS,  examination  of 143 

Location  of 144 

Nerves  of 146 

Sensory  center 96, 146 

Treatment  of 146,  208 

M 

MALLEOLI 177 

MKCKEL'S  GANGLION 69 

MECHANO-THERAPY 59 

MEISSNER,  plexus  of 198 

MESENTERY 158 

MEMBRANE,  costo-coracoid 129 

METRITIS 185 

METABOLISM 45 

MICRO-ORGANISMS 21,  34 

MISPLACEMENT,  correction  of   ...  184 

MOUTH 121 

MUSCLES  OF  NECK 122 

Of  shoulder 170 

Pyriformis 161 

Deltoid 168 

N 

NECK 121 

Muscles  of 122 

NERVES 25 

NKRVE  ACTION,  how  influenced. .  52 

Activity,  basic 56 

Depressor 88 

Seventh 120 

Fifth 120 

Circumflex 168 

Superscapular 168 

Pudic 184,  185,  199 

Sciatic 175,  203 

To  rhomboid 169 

Median 170 


Ulnar 170 

Obturator 175 

NERVI  ERIGENTES 78,  83 

NERVES,  sacral 83,  113,  199 

Of  vagina 83 

Of  uterus 83 

To  bladder 96,  104 

Laryngeal 126 

Of  intestine 194 

To  pelvic  organs 181 

NOTCH,  sacro-sciatic 161 

NUTRITION 102 

0 

OBSTETRICS 179 

OBSTRUCTION 45 

OLECRANON 171 

Os,  dilatation  of 188 

OSTEOPATHY  DEFINED    51 

OSTEOPATHY  A  SCIENCE 97 

OVARITIS  . .   185 

OVARY,  center  for 100 

Sensory  nerve  to 96 

OXIDATION 46 


PAIN,  a  warning 42 

Sign  of  a  lesion 43~47 

Superficial 47 

PALPATION 139 

PARTURITION 188 

PATELLA 175 

PELVIS 160 

PERICARDIUM 80 

PILO-MOTOR  NERVES 65 

PLACENTA 186-190 

PLEURA 80 

PLEXUS,  cavernous 68,  69 

Cardiac 78,  79 

Hypogastric 82 

Prevertebral .62 


217 


Pelvic 82 

Prostatic 83 

Solar 80,  155 

PRESSURE 48,  91 

PREGNANCY 187 

PROPHYLAXIS 19 

PROSTATE,  nerves  to 96 

PTOMAIN 35 

B 

RADIUS,  head  of 171 

RAMI  COMMUNICANTES 63 

Illustration  of 84 

RAMI  EFFKRBNTES 66,  88 

RECTUM,  center  for 103 

REGION,  suprascapular 132 

Suprasternal 124 

Superior  sternal 126 

Inferior  sternal 126 

Supraclavicular 127 

Infraclavicular 128 

Inframammary • 130 

REGIONS,  lateral 131 

Axillary 131 

Infraaxillary 132 

Posterior 132 

Subscapular 132,  134 

Infrascapular    134 

Interscapular 135 

RESORPTION 60 

RHEUMATISM 201  to  203 

RIBES,  ganglion  of 62 

RIBS,  setting 211 

RIGORS 210 

RING,  external  abdominal 148,  160 


SAPHENOUS  OPENING    173,  203 

SCALP 119 

SCIATICA  . .   209 

SHOULDER 128,  164 


Landmarks  of 165 

SPACE,  popliteal 177 

SPINE,  pubic 148,  162 

Anterior  superior  iliac 148 

Lesions  of n6 

SPINE,  examination  of. 114 

Landmarks  of. 117 

Ischiatic 161 

Posterior  inferior 161 

Of  ilium 173 

Leverage  on 169 

SPINAL  TREATMENT 107 

SPINOUS  PROCESSES 105 

SPLANCHNICS  74,  75,  81 

SPLEEN 94,  154 

STIMULATION  . .  .38,  48,  49,  52,  58,  112 
STOMACH,  sensory  nerves  to 

96,  154,  155 

Center 100,  103 

Treatment 209 

Location  of 131 

SUBOXIDES 20 

SUSCEPTIBILITY 39 

SYMPATHETIC  SYSTEM 61-85 

Cervical 73,  99 

Lumbar 77 

Sacral 77 

Sacral,  visceral  branches  of 78 

Thoracic 73,  74,  75 

SYMPHYSIS,  pubic .  .163 


TENESMUS 211 

TESTIS 96 

THORAX 123 

THYROID  gland 208 

TISSUES 41 

TONE 53,  55 

TOX- ALBUMIN 35 

TONSILS 208 

TOOTHACHE.  .  . .  .no 


218 


TORMINA 211 

TRACHEA 121 

TREATMENT  for  pelvic  trouble.  183-184 

TRIANGLE,  Scarpa 174 

TROCHAKTER  MAJOR 173 

TRUNK 94 

TUBKROSITV  ISCHII 162 

u 

UMBILICUS 144 

URETER,  nerves  to 83 

Sensory  nerves  to 96 

UTERUS,  nerves  of 83 

Sensory  nerves  to 97 

Position  of. 181 

Contraction  of 191 

Center  for 100,  104 

V 

VAGINA,  nerves  of 83 

VAGUS  NERVE 81,  156 


VAS  DEFERKNS 83 

VASO  CONSTRICTORS 

49,  64,  87,  90,  91,  107 

Constrictors  for  head 73 

Motors 85,  88,  91,  92 

Motors  center 85,  91,  92 

Motors  center  for  head,  throat, 

tonsils,  nose,  tongue,  eye 92 

VASO-DILATORS 86,  107 

VEINS,  innominate 122 

Short  saphenous 177 

Jugular 121 

VERTEBRA,  anterior 210 

VIEUSSENS,  annulus 72,  99 

VlSCERO-MOTOR 65,108 

w 

WATER 195-196 

WRIST 172 

Landmarks  of. 172 

Tendons  of 172 


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PRINTED   IN   U.S.A.  CAT.     NO.     24      161 


UC  SOUTHERN  REGIONAL  LIBRARY .FACILITY 


A     000510169     6 


UC  IRVINE  LIBRARY 


3  197001623  7858 


1900 


Riggs,  Wilfred  L 

Theory  of  osteopathy 


Riggs,  Wilfred  L 

Theory  of  osteopathy 


1900 


'It 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 

IRVINE,  CALIFORNIA  92664 


